{"hospital_name": "Memorial Herman Surgical Hospital First Colony", "last_updated_on": "2026-04-14", "version": "3.0.0", "pid": "1549931475", "rid": "12658", "location_name": ["Memorial Herman Surgical Hospital First Colony"], "hospital_address": ["16906 Southwest Fwy, Sugar Land, TX 77479"], "type_2_npi": ["1033114608"], "license_information": {"license_number": "100161", "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": "#2 FIBERSNARE #2 FIBERWIRE 26\" WH/BLUE AR-7209SNL", "code_information": [{"code": "AR-7209SNL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.3, "discounted_cash": 228.78, "setting": "both", "billing_class": "facility"}]}, {"description": ".04 KWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030-06-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12.78, "discounted_cash": 7.67, "setting": "both", "billing_class": "facility"}]}, {"description": "0.9% SOD.CHL.IRRIG. 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"maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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"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 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3", "code_information": [{"code": "1006023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 756.6, "setting": "both", "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": "3-0 WHITE S-FIBER 25 BRAIDED SUTURE ST-1 NEEDLE 50-1000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 288.0, "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": 4620.0, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"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": 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 X 24MM NON-LOCKING HEXALOBE SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 74.56, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM COUNTERSINK HEADLESS", "code_information": [{"code": "P20-915-3500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.82, "discounted_cash": 323.29, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM HEX DRIVER-MALE 03.611.103", "code_information": [{"code": "3.611.103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 235.84, "discounted_cash": 141.5, "setting": "both", "billing_class": "facility"}]}, {"description": "30 X 25 X 14MM 10? LUCENT MAGNUM 13025-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13025-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "30 X 25 X 14MM 6DEG LUCENT MAGNUM 13025-614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13025-614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "33332-0320-01 - influenza virus vaccine, inactivated preservative-free quadrivalent Susp", "code_information": [{"code": "90688", "type": "CPT"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 309.0, "discounted_cash": 185.4, "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": "33332-0320-01 - influenza virus vaccine, inactivated preservative-free quadrivalent Susp", "code_information": [{"code": "90688", "type": "CPT"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 309.0, "discounted_cash": 185.4, "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": "3500 SERIES RETENTION NUT CROSS CONNECTOR RN3501", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RN3501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3AF2535-1513 / ALIF F3D 25MM X 35MM X 13MM 15 DEGREE 3AF2535-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "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 MESH XL LEFT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "115312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 246.0, "setting": "both", "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", "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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", 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"fee schedule"}, {"payer_name": "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": "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": 1110.0, "discounted_cash": 666.0, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 LIVER TUMOR-CRYOSURGICAL 47371", "code_information": [{"code": "47371", "type": "CPT"}, {"code": "1479866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 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 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 516.91, "maximum": 8450.0, "gross_charge": 1068.0, "discounted_cash": 640.8, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 516.91, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATOR APOLLO RF I90 ASPIRATING 90 AR-9831", "code_information": [{"code": "AR-9831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 715.82, "discounted_cash": 429.49, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ASPIRATING 3MM 90DEG LOW PROFILE REPROCESS OPESINSTR", "code_information": [{"code": "AR9703A90R", "type": "CDM"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 153.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR SURGICAL MICRO 60DEG 2MM MONOPOLAR PROBE WITH SUCTION INTEGRATED CABLE", "code_information": [{"code": "7209641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.34, "discounted_cash": 281.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR SURGICAL MICRO 60DEG 2MM MONOPOLAR PROBE WITH SUCTION INTEGRATED CABLE REPROCESSED DISPOSABL", "code_information": [{"code": "7209641R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.1, "discounted_cash": 172.26, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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historical data found for payer/plan and coding 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 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"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": 1015.0, "discounted_cash": 609.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 376.97, "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", "code_information": [{"code": "59841", "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": "ABORTION", "code_information": [{"code": "59850", "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": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "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": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "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": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "ABORTION", "code_information": [{"code": "59857", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "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, "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "ACF 11X14MM 8MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILES TENDON 1.2 X 19.5CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "120190-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3990.0, "discounted_cash": 2394.0, "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 REPAIR TIGHTROPE WITH INTERNALBRACE AR-1588R-IB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588R-IB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1398.36, "discounted_cash": 839.02, "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 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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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 1952.0, "methodology": "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": 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": 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": 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 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", "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": "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": 173.53, "discounted_cash": 104.12, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER HUDSON", "code_information": [{"code": "AR-1416", "type": "CDM"}], "standard_charges": [{"gross_charge": 1166.15, "discounted_cash": 699.69, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER INJ SITE MALE LUER LOCK INTRLNK 2N3399", "code_information": [{"code": "2N3399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.18, "discounted_cash": 3.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER POCKET 2MM X 4MM SPINAL CORD STIMULATION", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "74002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 1188.0, "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": 1986.0, "discounted_cash": 1191.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER TAPER STANDARD TOTAL SHOULDER SYS VERSA-DIAL COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "118001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER TUBING Y TYPE DOUBLE SPIKE WAVE STRL", "code_information": [{"code": "AR-6215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.55, "discounted_cash": 44.73, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER VIAL DBM POSIFLOW", "code_information": [{"code": "385308", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER VIAL MULTIDOSE ULTRASITE", "code_information": [{"code": "413504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.98, "discounted_cash": 5.99, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER VIAL RECONSTITUTION DEV", "code_information": [{"code": "2B8071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.56, "discounted_cash": 6.94, "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", "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": "ADAPTOR AQUAPAK HUMIDIFLER HUD00040", "code_information": [{"code": "HUD00040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 1475.23, "maximum": 8450.0, "gross_charge": 3048.0, "discounted_cash": 1828.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1475.23, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 36.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.86, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.2, "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 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"plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "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 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3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "ADHESIVE MASTISOL 2/3CC VIAL FRN052348Z", "code_information": [{"code": "FRN052348Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.54, "discounted_cash": 10.52, "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": 45.97, "discounted_cash": 27.58, "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": 84.72, "discounted_cash": 50.83, "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": 80.62, "discounted_cash": 48.37, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE TOPICAL SKIN 0.8ML LIQIBAND", "code_information": [{"code": "LBF006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.1, "discounted_cash": 39.06, "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": "ADJ TISSUE TRANSFER EA ADD 30 SQ CM OR PART OF 14302", "code_information": [{"code": "14302", "type": "CPT"}, {"code": "1643965", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER 30.1-60.0 SQ CM 14301", "code_information": [{"code": "14301", "type": "CPT"}, {"code": "1479871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1028.5, "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": 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"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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 528.39, "discounted_cash": 317.03, "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 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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 PERFORM GLENOID CORTILOC- S40 DWE403", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 2535.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AERA ACCLARENT 1 PACK STR005439", "code_information": [{"code": "STR005439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3838.82, "discounted_cash": 2303.29, "setting": "both", "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": 1.8, "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": 4620.0, "methodology": "fee 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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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 3595.5, "discounted_cash": 2157.3, "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, 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"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": 5078.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.98, "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": 272.36, "discounted_cash": 163.42, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.78, "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": 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": 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"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 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"123134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.38, "discounted_cash": 6.23, "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": 10.18, "discounted_cash": 6.11, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 28FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE", "code_information": [{"code": "1230-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.97, "discounted_cash": 8.38, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 28FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE LF", "code_information": [{"code": "1231-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.18, "discounted_cash": 6.11, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 30FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE", "code_information": [{"code": "123030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.46, "discounted_cash": 11.08, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 32FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE", "code_information": [{"code": "123032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.46, "discounted_cash": 11.08, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 34FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE", "code_information": [{"code": "123034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.49, "discounted_cash": 12.29, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO SZ 26 ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE", "code_information": [{"code": "1230-26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.97, "discounted_cash": 8.38, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL ROBERTAZZI 30FR LF 123130", "code_information": [{"code": "123130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.18, "discounted_cash": 6.11, "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": 1.8, "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": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL CATH-GUIDE 120MM 1165", "code_information": [{"code": "1165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 100MM RED GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC P", "code_information": [{"code": "1160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 60MM SM CLR COLOR CODED LF", "code_information": [{"code": "1156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 80MM GRN GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC PO", "code_information": [{"code": "1158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.78, "discounted_cash": 2.27, "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": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ROBERTAZZI NASOPHARYNGEAL 28 FR 123128", "code_information": [{"code": "123128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.18, "discounted_cash": 6.11, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 217.75, "discounted_cash": 130.65, "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": 2990.0, "discounted_cash": 1794.0, "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": 3950.0, "discounted_cash": 2370.0, "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": 28000.0, "discounted_cash": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA SPINAL CORD STIMULATION SYSTEM TUNNELING TOOL", "code_information": [{"code": "5100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA SPINAL CORD TRIAL LEAD 12-ELECTRODE KIT", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1124-60T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 12MM 12 DEGREESE ALLOGRAFT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ALIF-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 12MM 8 DEGREESE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALIF1208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 14MM 12 DEGREESE ALLOGRAFT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ALIF-1412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "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": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 16MM 12 DEGREESE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALIF1612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 16MM 8 DEGREESE ALLOGRAFT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ALIF-1608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 18MM 12 DEGREES PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SS-A4118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9480.0, "discounted_cash": 5688.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 28 X 28 X 7 DEG 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "80712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF PEEK 14X34MM 12 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS143412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.94, "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 CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.3, "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": 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"standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 2412.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON 10 X 45.1-50MM GRACILLUS FROZEN PRESHAPED BLOCK PATELLAR BIO-CLEANSE", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "453002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6900.0, "discounted_cash": 4140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON 23CM X 6.0MM GRACILIS DOUBLE STRAND FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "26217000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON 50MM PATELLAR BONE HEMI", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "17822000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON ACHILLES W/STRUT MAXXEUS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1971-39", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4130.0, "discounted_cash": 2478.0, "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": 3075.0, "discounted_cash": 1845.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON GRACILLUS 11 X 11MM X 50-55MM BIO-CLENSE PRESHAPED PATELLAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "463005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON GRACILLUS NGR2033", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NGR2033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 2274.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON PRESUTURED GRAFTLINK", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "GRL-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 2760.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON SZ 10 TIBIALIS POST IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "453016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "setting": "both", 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"setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT W/INT. 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"standard_charges": [{"gross_charge": 582.48, "discounted_cash": 349.49, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLORAFT AMNIOTIC TISSUE INJ 1.0CC FROZEN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "BFA100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8700.0, "discounted_cash": 5220.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOSYNC DBM CB PASTE 3CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-2015-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1430.0, "discounted_cash": 858.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 2.5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-2010-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.8, "discounted_cash": 780.48, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOWRAP 2 X 2 DS WET", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3102-2002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 2224.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALOGRAFT FREEZE DRIED 6 X 11 X14MM 7 DEGREE CVA-061114-D7", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CVA-061114-D7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "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": 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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": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.27, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.89, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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 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": 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 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": 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": "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": "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 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.27, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.73, "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": 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 0.5ML OBS-905", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "OBS-905", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "both", "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": 500.0, "discounted_cash": 300.0, "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": 500.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIO LIQUID 1ML OBS-910", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "OBS-910", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "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": 1000.0, "discounted_cash": 600.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "AMNION LIQUID 0.5ML", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "930-RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "gross_charge": 500.0, "discounted_cash": 300.0, "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": "AMNION PATCH 4X6CM RSX-AC-0406", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "RSX-AC-0406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNION PATCH DUAL LAYER STERISHIELD II 4CM X 8CM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "ACG835", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 8250.0, "discounted_cash": 4950.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNION PATCH MEDIUM THICKNESS 4X4 AS-APM44", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AS-APM44", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNION STERISHIELD II DUAL LAYER", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "MA835", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 1980.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "AMNIOTIC PATCH 4.0X4.0CM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "TM-AMN1404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4990.0, "discounted_cash": 2994.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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 FINGER OR THUMB PRIMARY OR SECONDARY 26951", "code_information": [{"code": "26951", "type": "CPT"}, {"code": "1479890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 2989.0, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 2989.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1958.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": "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 KNEE BELOW 27880", "code_information": [{"code": "27880", "type": "CPT"}, {"code": "1479897", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 940.83, "maximum": 14796.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "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": 940.83, "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": "AMPUTATION METACARPAL W/FINGER OR THUMB 26910", "code_information": [{"code": "26910", "type": "CPT"}, {"code": "1479900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "AMPUTATION METATARSAL W/TOE-SINGLE 28810", "code_information": [{"code": "28810", "type": "CPT"}, {"code": "1479901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": "25900", "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": "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": 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": "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": "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 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"AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"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": 2019.24, "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE AT INTERPHALANGEAL JOINT 28825", "code_information": [{"code": "28825", "type": "CPT"}, {"code": "1479909", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": "AMPUTATION TOE AT METATARSALPHALANGEAL JOINT 28820", "code_information": [{"code": "28820", "type": "CPT"}, {"code": "1479910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 1958.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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 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"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 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 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"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": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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"standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"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": 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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"CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], 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{"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": 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{"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 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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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 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 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"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", 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 58.17, "discounted_cash": 34.9, "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": "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": 10000.0, "discounted_cash": 6000.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "ANORECTAL MYOMECTOMY 45108", "code_information": [{"code": "45108", "type": "CPT"}, {"code": "1479924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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 W/REMOVAL OF SINGLE TUMOR POLYP OR OTHER LESION BY HOT BIOPSY OR BIPOLAR 46610", "code_information": [{"code": "46610", "type": "CPT"}, {"code": "42873623", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "ANOSCOPY WITH DILATION BALLOON/WIRE/BOUGIE 46604", "code_information": [{"code": "46604", "type": "CPT"}, {"code": "9975582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 548.37, "maximum": 8450.0, "gross_charge": 1133.0, "discounted_cash": 679.8, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 548.37, "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; DIAGNOSTIC INCL. 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"RC"}], "standard_charges": [{"minimum": 521.26, "maximum": 8450.0, "gross_charge": 1077.0, "discounted_cash": 646.2, "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": 521.26, "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": 6074.0, "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": 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3001.76, "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": 2046.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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": 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"standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 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"AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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"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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", 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"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", 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{"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 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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"AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.46, "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": 0.51, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.62, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.57, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": "AOS SCREW 5.0 X 48 MM CAPT. CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8001-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 725.9, "discounted_cash": 435.54, "setting": "both", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "APOLLO DISPOSABLE PUNCH", "code_information": [{"code": "-55P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.9, "discounted_cash": 229.14, "setting": "both", "billing_class": "facility"}]}, {"description": "APOLLO MEDIAL WITH NEEDLES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27-11145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1106.0, "discounted_cash": 663.6, "setting": "both", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "APPENDECTOMY", "code_information": [{"code": "44950", "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": 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", "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 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": 5628.0, "discounted_cash": 3376.8, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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": 9735.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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+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", "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": 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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "APPLICATION CRANIAL TONGS 20660", "code_information": [{"code": "20660", "type": "CPT"}, {"code": "1479952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2204.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 6202.0, "discounted_cash": 3721.2, "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": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOW COST SUB. GRAFT TO TRK/LEGS/ARMS TOT. WOUND UP TO 100SQ CM FIRST 25SQ CM LESS C5271", "code_information": [{"code": "C5271", "type": "HCPCS"}, {"code": "42593889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1513.46, "maximum": 3827.0, "gross_charge": 3127.0, "discounted_cash": 1876.2, "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 POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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", "standard_charge_dollar": 1513.46, "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": "APPLICATION MULTIPLANE UNILATERAL EXT. FIX. W/STEREOTACTIC 20696", "code_information": [{"code": "20696", "type": "CPT"}, {"code": "8043484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "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": 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": "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 BODY CAST", "code_information": [{"code": "29046", "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 FIGURE EIGHT", "code_information": [{"code": "29049", "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 HIP CAST", "code_information": [{"code": "29305", "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 HIP CASTS", "code_information": [{"code": "29325", "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": 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": 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 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 ARM CAST", "code_information": [{"code": "29065", "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", "code_information": [{"code": "29355", "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", "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 SPLINT-THIGH TO ANKLE/TOES 29505", "code_information": [{"code": "29505", "type": "CPT"}, {"code": "1479961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 331.8, "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": 267.65, "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. 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SYSTEM 20692", "code_information": [{"code": "20692", "type": "CPT"}, {"code": "1479955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "methodology": "fee schedule"}, {"payer_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 SHOULDER CAST", "code_information": [{"code": "29055", "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 SHOULDER CAST", "code_information": [{"code": "29058", "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 UNIPLANE UNILATERAL EXT. 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SYSTEM 20690", "code_information": [{"code": "20690", "type": "CPT"}, {"code": "1479956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 225.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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. 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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": 763.0, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 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{"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 FINGER-STATIC 29130", "code_information": [{"code": "29130", "type": "CPT"}, {"code": "1479971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 331.8, "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", 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"gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 225.0, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 331.8, "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": 267.65, "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": 225.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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"discounted_cash": 10.43, "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": 31.34, "discounted_cash": 18.8, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML TEAL SCRUB CHLORAPREP LF", "code_information": [{"code": "260825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.31, "discounted_cash": 24.19, "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": 5.08, "discounted_cash": 3.05, "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": 18.37, "discounted_cash": 11.02, "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": 3.0, "discounted_cash": 1.8, "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": 590.1, "discounted_cash": 354.06, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR FLOSEAL MLBL TRM TIP", "code_information": [{"code": "1502186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 4.66, "discounted_cash": 2.8, "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": 92.07, "discounted_cash": 55.24, "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": 88.75, "discounted_cash": 53.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATR MBO CHLORAPREP ORANGE TINT 3ML 930415", 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329.62, "discounted_cash": 197.77, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 5MM MULTIPLE ENDO ROTATING LF STRL DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "ETHEL5ML", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 308.76, "discounted_cash": 185.26, "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": 297.55, "discounted_cash": 178.53, "setting": 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.55, "discounted_cash": 110.73, "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": 151.31, "discounted_cash": 90.79, "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": 119.67, "discounted_cash": 71.8, "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": 58.34, "discounted_cash": 35.0, "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": 97.79, "discounted_cash": 58.67, "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": 3.0, "discounted_cash": 1.8, "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": 297.55, "discounted_cash": 178.53, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "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 HAND/WRIST CAST", "code_information": [{"code": "29085", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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 LONG LEG CAST BRACE", "code_information": [{"code": "29358", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 218.28, "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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", 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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 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2019.24, "maximum": 9357.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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 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"standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARENA-L ALLO 13MM 7260", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "7260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AROMATAB ELEQUILLAVENDERPEPPERMINT 50 PER BOX BKY373", "code_information": [{"code": "BKY373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.7, "discounted_cash": 9.42, "setting": "both", "billing_class": "facility"}]}, {"description": "AROMATABS LAVENDER PEPPERMINT 373", "code_information": [{"code": "373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.57, "discounted_cash": 8.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": 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"standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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", "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", "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": 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": 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": 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", "standard_charge_dollar": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "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", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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 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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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", "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1301.0, "methodology": "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": 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": 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": 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 1036.2, "maximum": 14796.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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", "standard_charge_dollar": 1519.76, "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": 1036.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee 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"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": 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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 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": 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 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"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 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": 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 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": 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": "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": 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 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": 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 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"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": 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 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 SMALL JT OR BURSA W/ULTRASOUND 20604", "code_information": [{"code": "20604", "type": "CPT"}, {"code": "38612797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 5628.0, "discounted_cash": 3376.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 88.23, "discounted_cash": 52.94, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 12X59", "code_information": [{"code": "179301", "type": "CDM"}], "standard_charges": [{"gross_charge": 97.09, "discounted_cash": 58.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 16X59", "code_information": [{"code": "179303", "type": "CDM"}], "standard_charges": [{"gross_charge": 94.46, "discounted_cash": 56.68, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 20X59", "code_information": [{"code": "179305", "type": "CDM"}], "standard_charges": [{"gross_charge": 97.09, "discounted_cash": 58.25, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 59.06, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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"standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "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 OR RELEASE OF VITREOUS 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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 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"plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.75, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.48, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.65, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.06, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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{"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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.66, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.88, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.66, "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": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.25, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.95, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.73, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.09, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.58, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.68, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.2, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.48, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.91, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.49, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.59, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.33, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.78, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.25, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.96, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 LIPOPROTEIN", "code_information": [{"code": "83721", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.96, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.5, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.73, "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": 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 CALCITONIN", "code_information": [{"code": "82308", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.35, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.24, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.55, "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.3, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.15, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.43, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.15, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.94, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.86, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 89.04, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.34, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 224.09, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.85, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.51, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.21, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.4, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.41, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.89, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.61, "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.73, "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": 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 FREE TESTOSTERONE", "code_information": [{"code": "84402", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.95, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.21, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.53, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.28, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.11, "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.05, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.4, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.24, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.41, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 12.11, "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"}], 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.3, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.15, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.66, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.4, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.78, "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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.99, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.88, "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.14, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.75, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.68, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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 LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.53, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.96, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.5, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.21, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.12, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.85, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.65, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.03, "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": 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 PREALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.2, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.54, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.21, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.3, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.71, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.19, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.36, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 14.31, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.1, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.07, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.75, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "ASSAY OF SEX HORMONE GLOBUL", "code_information": [{"code": "84270", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.54, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.74, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.33, "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": 64.29, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.81, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.61, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "ASSAY OF THEOPHYLLINE", "code_information": [{"code": "80198", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.69, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.89, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 TOTAL TESTOSTERONE", "code_information": [{"code": "84403", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.82, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.7, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.64, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.11, "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.7, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.6, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 39.53, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.55, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.91, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.61, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.36, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.99, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.75, "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 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"plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.91, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.26, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.14, "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": 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.05, "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.98, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.97, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.46, "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": 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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.13, "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": 321.04, "discounted_cash": 192.62, "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": 326.63, "discounted_cash": 195.98, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY HUMERAL 4IN REGINTERCHANGEABLE TOTAL ELBOW COONRAD MORREY IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-26-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8600.0, "discounted_cash": 5160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY LENENER MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4960-3-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6230.16, "discounted_cash": 3738.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY PLATE 24MM ANT CERVICAL 2 LEVEL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71002-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5742.0, "discounted_cash": 3445.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY PLATE 26MM ANT CERVICAL 2 LEVEL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71002-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5742.0, "discounted_cash": 3445.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY PLATE SZ 20 15MM JOINT RADIOULNAR DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DRUJ-P20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7802.0, "discounted_cash": 4681.2, "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": 95.85, "discounted_cash": 57.51, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY ULNAR TOTAL ELBOW XS 3IN RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-043-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6400.0, "discounted_cash": 3840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY ULNAR TOTAL ELBOW XS 4IN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-27-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 4202.4, "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 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"standard_charge_dollar": 2204.0, "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", 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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"standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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 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"plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.05, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.93, "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": 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, 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"plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.53, "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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.01, "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": 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": "ATOMIZER LARYNG-TRACH DEVICE SYRINGE 3ML", "code_information": [{"code": "MAD600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.26, "discounted_cash": 34.96, "setting": "both", "billing_class": "facility"}]}, {"description": "ATOMIZER LMA MADGIC LARYNGOTRACHEAL MUCOSAL 3 ML SYRINGE HUDMAD600", "code_information": [{"code": "HUDMAD600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.93, "discounted_cash": 29.36, "setting": "both", "billing_class": "facility"}]}, {"description": "ATOMIZER MUCOSAL ATMZR DEVICE NO SYRNG MAD300", "code_information": [{"code": "MAD300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.5, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE 0.4MG/1ML VIAL", "code_information": [{"code": "MED0466", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 40.7, "discounted_cash": 24.42, "setting": "both", "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": 74.26, "discounted_cash": 44.56, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "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": 0.51, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 6640.0, "discounted_cash": 3984.0, "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 SINGLE CHIN 21121", "code_information": [{"code": "21121", "type": "CPT"}, {"code": "1480138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2279.15, "maximum": 8450.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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 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"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": 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": "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": "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": "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": 493.5, "discounted_cash": 296.1, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "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": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "AUTOLOGOUS TISSUE COLLECTOR", "code_information": [{"code": "ABS-1050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.73, "discounted_cash": 703.64, "setting": "both", "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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) GROSS", 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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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", 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"standard_charge_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": 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.1, "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", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee 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": 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 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{"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": 212.14, "discounted_cash": 127.28, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "BACI/NEO/POLY(NEOSPORIN OPHTH) 3.5GM", "code_information": [{"code": "MED0017", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.98, "discounted_cash": 28.19, "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": 3.0, "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": 7.26, "discounted_cash": 4.36, "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": 292.66, "discounted_cash": 175.6, "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": 24.45, "discounted_cash": 14.67, "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": 3.0, "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": 3.0, "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": 3.0, "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": 23.06, "discounted_cash": 13.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN/NEOMYCIN/POLYMYXIN B TOP OINT (NEOSPORIN) 30 GM", "code_information": [{"code": "MED0829", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.49, "discounted_cash": 5.09, "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": 56.04, "discounted_cash": 33.62, "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": "BACLOFEN 0.05 MG/ML INTRATHECAL SOL 1 ML KIT", "code_information": [{"code": "MED0024", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 237.25, "discounted_cash": 142.35, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.19, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "BAG AMBU ADULT", "code_information": [{"code": "2K8004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.21, "discounted_cash": 31.93, "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": 7.65, "discounted_cash": 4.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BREATHING 2LT GRN SMOOTH LF", "code_information": [{"code": "DYNJAA02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.09, "discounted_cash": 10.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG CLEAR DRAWCORD 19 X 21", "code_information": [{"code": "MDC-CLR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DECANTER BD100", "code_information": [{"code": "BD100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.3, "discounted_cash": 6.18, "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": 17.54, "discounted_cash": 10.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAIN 350 ML URINE METERINFECTION CONTROL", "code_information": [{"code": "153214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 164.4, "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": 21.33, "discounted_cash": 12.8, "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": 9.48, "discounted_cash": 5.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG LEG 9 OUNCH LG UROLOGY PATIENT CARE", "code_information": [{"code": "150103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.63, "discounted_cash": 6.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG MANUAL RESUSCITATOR RESPIRATORY AIRLIFE LATEX FREE MASK INFANT 40IN", "code_information": [{"code": "2K8008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.05, "discounted_cash": 55.23, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG PAIN PUMP", "code_information": [{"code": "21-2171-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.61, "discounted_cash": 41.17, "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": 232.29, "discounted_cash": 139.37, "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": 130.47, "discounted_cash": 78.28, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG STAT BIOHAZ LABGUARD 6X9 CH6X9STAT", "code_information": [{"code": "CH6X9STAT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG W/RUBBERBAND & TAPE 36INCH X 30INCH BANDED", "code_information": [{"code": "63630R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.55, "discounted_cash": 14.13, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG WITH ELASTIC BAND STERILE 36INCH X 28INCH RECTANGUALR DYNJE63628R", "code_information": [{"code": "DYNJE63628R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.81, "discounted_cash": 3.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BAGMESH PRESSURE INFUSION BACK 3000ML 8809", "code_information": [{"code": "8809", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BAGS BAND 30 X 36 DYNJE63036R", "code_information": [{"code": "DYNJE63036R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.24, "discounted_cash": 6.14, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIR PAWS WARMING GOWN ADULT STANDARD 81001", "code_information": [{"code": "81001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.32, "discounted_cash": 9.79, "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": 1.8, "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": 1607.58, "discounted_cash": 964.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATH 10 TO 12MM CRE WG", "code_information": [{"code": "M00558680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.31, "discounted_cash": 336.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATH 12 TO 15MM CRE WG", "code_information": [{"code": "M00558690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.31, "discounted_cash": 336.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATHETER ZVPLASTY 10G KYPHOPLASTY KIT WITH 15MM VCF-1015-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VCF-1015-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18000.0, "discounted_cash": 10800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATHETER ZVPLASTY 15MM LENGTH 14MM VCF-1000-15", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "VCF-1000-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DILATATION CATHETER: 6MM / 7MM / 8MM CRE FIXED WIRE ESOPHAGEAL M00558330", "code_information": [{"code": "M00558330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.55, "discounted_cash": 261.33, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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6MM MA FRNTAL SPHENDIO", "code_information": [{"code": "RSP0616MFSN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4465.5, "discounted_cash": 2679.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON ORBERA INTRAGASTRIC B-4800", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "B-4800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 2220.0, "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": 706.29, "discounted_cash": 423.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PREPERITONEAL DIST OMSPDB1000", "code_information": [{"code": "OMSPDB1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1009.45, "discounted_cash": 605.67, "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": 4465.5, "discounted_cash": 2679.3, "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 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"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 LAP BARIATRIC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "B-2360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7190.0, "discounted_cash": 4314.0, "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 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6300.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAND WEDDING DOMINO OPEN 4.75/4.75", "code_information": [{"code": "14-589674", "type": "CDM"}], "standard_charges": [{"gross_charge": 6300.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAND WEDDING DOMINO OPEN 4.75/5.5", "code_information": [{"code": "14-589675", "type": "CDM"}], "standard_charges": [{"gross_charge": 6300.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHES STRIP WOVEN COVERLET 1 X 3 00231", "code_information": [{"code": "231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHES TENSOPLAST 4\"X 5YD WHITE 02596002", "code_information": [{"code": "2596002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.41, "discounted_cash": 17.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHSV 2IN X 4 1/2IN STRL", "code_information": [{"code": "5716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 7.71, "discounted_cash": 4.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COHESIVE 4IN X 5YD LF SELF ADHERENT LIGHTWEIGHT BREATHABLE", "code_information": [{"code": "CAH45LFS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.76, "discounted_cash": 4.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COMPRESS 4INX210IN ELAS HONEYCMB", "code_information": [{"code": "23593-04LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.51, "discounted_cash": 2.11, "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": 4.77, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COMPRESSION 3IN X 5YD WHT ADHSV ELASTIC TENSOPLAST", "code_information": [{"code": "2595002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.86, "discounted_cash": 11.32, "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": 3.97, "discounted_cash": 2.38, "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": 4.72, "discounted_cash": 2.83, "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": 1.8, "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": 1.8, "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": 3.0, "discounted_cash": 1.8, "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": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORMING 6IN X 4 1/10YD GAUZE ELASTIC SOF FORM", "code_information": [{"code": "NON25499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELAS 2INX210IN LF ELITE", "code_information": [{"code": "23593-02LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 3IN X 5.5YD HONEYCOMB VELCRO CLOSURE BEIGE LF", "code_information": [{"code": "23593-03LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 38.18, "discounted_cash": 22.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 6IN X 5.8YD HONEYCOMB VELCRO CLOSURE BEIGE LF", "code_information": [{"code": "23593-16LF", "type": 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SLF ADHERENT 2IN X 5YD TAN SLF ADHERENT NON WOVEN MATERIAL AND ELASTIC F", "code_information": [{"code": "1582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.28, "discounted_cash": 2.57, "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": 12.0, "discounted_cash": 7.2, "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": 18.63, "discounted_cash": 11.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE STRETCH CONFORM 4INX4.1YD STER", "code_information": [{"code": "2236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 1IN X 5YD BLUE SLF ADHERENT USED FOR THE EFFECTIVE TREATMENT OF VENO", "code_information": [{"code": "1581B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 2IN X 5YD WHT BEIGE VELCRO CLOSURE MED COMPRESSION ELSTC POLYESTER C", "code_information": [{"code": "MDS087002LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 4IN X 5YD TAN SLF ADHERENT FOR THE EFFECTIVE TREATMENT OF VENOUS LEG", "code_information": [{"code": "1584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.43, "discounted_cash": 5.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 4IN X 5YD TAN SLF ADHERENT HND TEAR FOAM CO FLEX LF STRL", "code_information": [{"code": "DYNJ089004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.04, "discounted_cash": 9.62, "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": 10.81, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 4IN X 5YD WHT BEIGE VELCRO CLOSURE MED COMPRESSION ELSTC POLYESTER C", "code_information": [{"code": "MDS087004LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 7.25, "discounted_cash": 4.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WOUND 3/4IN X 3IN PINK BLUE ADHSV CAMO PRINT FABRIC CURAD LF", "code_information": [{"code": "45702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.19, "discounted_cash": 7.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE.ESMARK LATEX FREE 4X9 CTM UMMS 99301", "code_information": [{"code": "99301", 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"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": 234.0, "discounted_cash": 140.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM ENEMA RING 204503 204503", "code_information": [{"code": "901101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.1, "discounted_cash": 12.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM EXPAQUE 6.2OZ SUSPENSION SULFATE", "code_information": [{"code": "750", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.04, "discounted_cash": 3.62, "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": 454.0, "discounted_cash": 272.4, "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": 6900.0, "discounted_cash": 4140.0, "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 MEMBRANE 4 X 8CM AMNIOTIC", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "AM20-4X08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "gross_charge": 7134.0, "discounted_cash": 4280.4, 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, 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VANGAURD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "183424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2194.0, "discounted_cash": 1316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 14MM X 67MM ANT STABILISED VANGUARD IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "189044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2284.0, "discounted_cash": 1370.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 14MM X 79/83MM POST STABILISED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2710.0, "discounted_cash": 1626.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 63/67 X 10MM MODULAR CRUCIATE RETAINING COMPLETE KNEE SYS VANGUARD", 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VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2710.0, "discounted_cash": 1626.0, "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, 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"RC"}], "standard_charges": [{"gross_charge": 4.97, "discounted_cash": 2.98, "setting": "both", "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 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CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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 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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 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"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": 114.4, "discounted_cash": 68.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BETAMETHASONE 6 MG/ML PF INJ SOLN 1 ML", "code_information": [{"code": "MED0826", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 63.84, "discounted_cash": 38.3, "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 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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", "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": 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": "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": "BIASURGE ADVANCED SURGICAL SOLUTION, 1.0L BAG BAS-0106", "code_information": [{"code": "BAS-0106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.55, "discounted_cash": 261.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BICILLIN L-A PENICILLIN G BENZATHINE 1.2MMU/2ML 10 X 2ML", "code_information": [{"code": "4000817", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 297.26, "discounted_cash": 178.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BIFURCATED LIGHT SOURCE", "code_information": [{"code": "GZA160002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1374.0, "discounted_cash": 824.4, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.01, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.43, "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "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 ABDOMINAL 3 PANEL", "code_information": [{"code": "13661056", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 EYELID & LID MARGIN", "code_information": [{"code": "67810", "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "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": "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": 55.32, "discounted_cash": 33.19, "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": 55.32, "discounted_cash": 33.19, "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": 55.32, "discounted_cash": 33.19, "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": 26.36, "discounted_cash": 15.82, "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": 26.36, "discounted_cash": 15.82, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 26.36, "discounted_cash": 15.82, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 26.36, "discounted_cash": 15.82, "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": 26.36, "discounted_cash": 15.82, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 26.36, "discounted_cash": 15.82, "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": 27.84, "discounted_cash": 16.7, "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": 27.84, "discounted_cash": 16.7, "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": 49.75, "discounted_cash": 29.85, "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": 49.75, "discounted_cash": 29.85, "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": 49.75, "discounted_cash": 29.85, "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": 386.93, "discounted_cash": 232.16, "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": 55.32, "discounted_cash": 33.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "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 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"code_information": [{"code": "30100", "type": "CPT"}, {"code": "3548589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 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{"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 CERVIX W/SCOPE", "code_information": [{"code": "57455", "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": 2204.0, "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 CORNEA 65410", "code_information": [{"code": "65410", "type": "CPT"}, {"code": "1480164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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"plan_name": "HUMANA HMO", "standard_charge_dollar": 1027.53, "methodology": "fee schedule"}, {"payer_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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 EXTERNAL EAR", "code_information": [{"code": "69100", "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": "BIOPSY OF EXTERNAL EAR CANAL", "code_information": [{"code": "69105", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "BIOPSY OF EYELID LINING", "code_information": [{"code": "68100", "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": 3365.0, "methodology": "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": 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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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", "standard_charge_dollar": 8450.0, "methodology": "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": 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": "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", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 940.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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 MOUTH LESION", "code_information": [{"code": "40808", "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 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"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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "BIOPSY OF SALIVARY GLAND; NEEDLE 42400", "code_information": [{"code": "42400", "type": "CPT"}, {"code": "42891950", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, 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"BLADE SURG FULL RADIUS SAMURAIINSTR", "code_information": [{"code": "CAT00227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.18, "discounted_cash": 351.11, "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": 43.76, "discounted_cash": 26.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG RAD60 CRVD 360DEG 4MM X 11CM STRAIGHTSHOT M4 ROT OFFSET", "code_information": [{"code": "1884016HRE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 555.71, "discounted_cash": 333.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG RAD90 3.5MM X 11CM STRAIGHTSHOT M4 ROTATABLE CRVD SHAFT OFFSET", "code_information": [{"code": "1883519HRE", "type": 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"2108-113R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.3, "discounted_cash": 85.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE, LARYNGOSCOPE, F / O, MAC,#2, CHILD", "code_information": [{"code": "MDS0425115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.73, "discounted_cash": 136.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES MEDLINE SURGICAL CLIPPER UBLADEFL", "code_information": [{"code": "UBLADEFL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.88, "discounted_cash": 7.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES SAW OXFORD KNEE RESEC CMNTD 3PK", "code_information": [{"code": "506266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 768.0, "discounted_cash": 460.8, "setting": "both", "billing_class": "facility"}]}, 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historical data found for payer/plan and coding 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.96, "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": "BLEPHAROPLASTY REVISION LOWER EYELID 15820", "code_information": [{"code": "15820", "type": "CPT"}, {"code": "1480197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 1027.53, "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": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 5172.0, "maximum": 6045.0, "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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "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 20MM 60FR SIDE PORT MAXI WITH STRAP LATEX FREE DISPOSABLE", "code_information": [{"code": "712804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.06, "discounted_cash": 6.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK BITE STANDARD NO STRAP 16MM/48FR", "code_information": [{"code": "712802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.41, "discounted_cash": 11.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK PLATFORM CM 2 X 6.25 X 0.04CM 5CC", "code_information": [{"code": "CM2SSOS", "type": "CDM"}], "standard_charges": [{"gross_charge": 3046.0, "discounted_cash": 1827.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK PLATFORM CM 2 X 6.25 X 0.08CM 1OCC", "code_information": [{"code": "CM2SS10", "type": "CDM"}], "standard_charges": [{"gross_charge": 4410.0, "discounted_cash": 2646.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK PLATFORM CM 2 X 6.25 X 0.08CM 20CC", "code_information": [{"code": "CM2SS20", "type": "CDM"}], "standard_charges": [{"gross_charge": 8820.0, "discounted_cash": 5292.0, "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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": "BLOCK SPACER W/ RETAINING SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "510-08-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3192.0, "discounted_cash": 1915.2, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.24, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.46, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.05, "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 PLATELET AGGREGATION", "code_information": [{"code": "85576", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "BLOOD PRESSURE CUFF ADULT LONG MDS9913HPLCS", "code_information": [{"code": "MDS9913HPLCS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.94, "discounted_cash": 4.76, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 TRANSFER DEVICE BTRD", "code_information": [{"code": "BTRD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 30.32, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "BLOODPRESSURE CHILD 1 TUBE", "code_information": [{"code": "MDS9911HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "discounted_cash": 4.38, "setting": "both", "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": 2290.0, "discounted_cash": 1374.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUEPRINT PERFORM + GLENOID GUIDE", "code_information": [{"code": "MWJ021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2290.0, "discounted_cash": 1374.0, "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": 2290.0, "discounted_cash": 1374.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BMA KIT RAN-11C", "code_information": [{"code": "RAN-11C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1832.0, "discounted_cash": 1099.2, "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": "BMT 360 5MM OFFSET ADAPTER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2176.0, "discounted_cash": 1305.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB AUG 75X5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2836.0, "discounted_cash": 1701.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB LG CRUCIATE WING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1996.0, "discounted_cash": 1197.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB TRAY 75MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7080.0, "discounted_cash": 4248.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT SPLINED KNEE STM V2 18X40 148293", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "148293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4486.0, "discounted_cash": 2691.6, "setting": "both", "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 FINNED TITANIUM ALLOY W/ LOCKING SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1350.15.110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4860.0, "discounted_cash": 2916.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOJRAB ALTO TOTAL 625B", "code_information": [{"code": "L8613", "type": "HCPCS"}, {"code": "625B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 892.0, "discounted_cash": 535.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLSTER RETENTION FOR SUT", "code_information": [{"code": "450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.3, "discounted_cash": 4.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 16 MM RR1600", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RR1600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT DYNABUNION ANTI-DRIFT 3.5 X 34MM 15FT-3534", "code_information": [{"code": "15FT-3534", "type": "CDM"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT DYNABUNION ANTI-DRIFT 3.5 X 36MM 15FT-3536", "code_information": [{"code": "15FT-3536", "type": "CDM"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT DYNABUNION ANTI-DRIFT 3.5 X 38MM 15FT-3538", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15FT-3538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT EX FIX 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RR2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT EXTRACTION FOR 2 MM SCREW", "code_information": [{"code": "309.19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 399.49, "discounted_cash": 239.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT FOR FEMORAL NECK SUSTEM 90 LENGTH-S 04.168.290S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4.168.290S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.2, "discounted_cash": 681.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC 44MM MODULAR FEMORAL REV SYS LAT ARCOS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-302144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR BC ACHILLES SPDBRG W/ KL DX CC 3.9 MM AR-9928BCK-DX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9928BCK-DX", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6276.36, "discounted_cash": 3765.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHRO TIGHTROPE\u00c2\u00ae II BTB RECON IB\u00e2\u201e\u00a2 AR-1588BTB-IB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB-IB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1398.36, "discounted_cash": 839.02, "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": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CHIPS 30CC (4-10MM) AT809FD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AT809FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CHIPS 30CC AT808FD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AT808FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CHIPS 30CC OBS-330", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "OBS-330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "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": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CRUSHED FINE 10CC 1116-12", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1116-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CEMENT 70GM HV 71271605", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CHIPS 5CC ZV-DG-5", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ZV-DG-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CHIPS CANCELLOUS 1-4MM 15CC CFB-15G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CFB-15G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20000.0, "discounted_cash": 12000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CHIPS CANCELLOUS FREEDOM 1-4MM 30CC CFB-30G", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CFB-30G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 36000.0, "discounted_cash": 21600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CHIPS CANCELLOUS FREEDOM 1-4MM 5CC CFB-05G", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CFB-05G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 5400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CHIPS MLZED GRANULES 1-4MM, 10CC ZV-DG-10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ZV-DG-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "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": 56000.0, "discounted_cash": 33600.0, "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": 254.6, "discounted_cash": 152.76, "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": 20513.67, "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", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "K20001510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 2274.0, "setting": "both", "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": 3600.0, "discounted_cash": 2160.0, "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": 13980.0, "discounted_cash": 8388.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT FEMORAL HEAD & NECK 27170", "code_information": [{"code": "27170", "type": "CPT"}, {"code": "1480202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1785.96, "maximum": 9735.0, "gross_charge": 5412.0, "discounted_cash": 3247.2, "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": 2619.4, "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": 1785.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT GENEX 5CC KIT W/ BEAD MOLD TRAY 910-005Z", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "910-005Z", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3850.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT HARVISTORY FENSTRATION PERFORATOR 12MM P99-100-2010", "code_information": [{"code": "P99-100-2010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 566.22, "discounted_cash": 339.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFTING 10ML PHYSIO MOLDABLE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PHM-9110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8200.0, "discounted_cash": 4920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFTING KIT-ALLOSYNC PURE 2.5CC BIO SURGE I ABS-2016-01", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-2016-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3035.2, "discounted_cash": 1821.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRANULES 2MM-3MM 5CC CALCIUM PHOSPHATE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "65-0205-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 578.4, "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": 2700.0, "discounted_cash": 1620.0, "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": 5287.5, "discounted_cash": 3172.5, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 1301.0, "methodology": "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": 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": 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": 1301.0, "methodology": "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": 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": 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": 3771.0, "discounted_cash": 2262.6, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1825.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "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 ASPIRATION ONLY 38220", "code_information": [{"code": "38220", "type": "CPT"}, {"code": "1643980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "BONE MARROW BIOPSY; NEEDLE OR TROCAR 38221", "code_information": [{"code": "38221", "type": "CPT"}, {"code": "43040996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 516.91, "maximum": 8450.0, "gross_charge": 1068.0, "discounted_cash": 640.8, "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": 516.91, "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": "BONE MARROW HARVESTING FOR TRANSPLANTATION / ALLOGENEIC 38230", "code_information": [{"code": "38230", "type": "CPT"}, {"code": "3548680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 4620.0, "methodology": "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": 537.24, "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": 2989.0, "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": 537.24, "maximum": 9357.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 537.24, "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": 9357.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 1765.0, "discounted_cash": 1059.0, "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": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX ALLOSYNC PURE 1.0CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-2010-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.4, "discounted_cash": 390.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX IMPLANT UNIFUZE BLOCK 5CC 6.25 X 2 X 0.4CM 801-0005", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "801-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX V92 FC+ 5.0CC P01-V92-0502", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P01-V92-0502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 1952.0, "methodology": "fee schedule"}, {"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": 8450.0, "methodology": "fee 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.05, "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 MODEL PAT SPECIFIC", "code_information": [{"code": "98-8500-000-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4580.0, "discounted_cash": 2748.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY 5CC HP-05P", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HP-05P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY 5CC ZVP-05.00", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ZVP-05.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY 5CC ZVPCM-5.00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZVPCM-5.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "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": 880.0, "discounted_cash": 528.0, "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": 246.4, "discounted_cash": 147.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 3.5MM X 48MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 144.6, "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": 325.38, "discounted_cash": 195.23, "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": 162.0, "discounted_cash": 97.2, "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": 2127.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLES 3 ARTHROSCOPIC DELIVERY SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2503-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STRIP 10CC 801-0010", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "801-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STRIP 5CC 802-0005", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "802-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14000.0, "discounted_cash": 8400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STRIP SYNTHETIC", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "EBF1-100X25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SUB OPTIFUSE 10 X 25 X 4MM STRIP", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "OM1-100X25-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6590.0, "discounted_cash": 3954.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 10ML CERAMENT A0210-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A0210-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10780.0, "discounted_cash": 6468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX LUKENS 901", "code_information": [{"code": "901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.87, "discounted_cash": 11.92, "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BONECAM SMALL JOINT ANHCOR 08-11108", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8-11108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1248.0, "discounted_cash": 748.8, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "BORE TAP CANNULATED 4.5MM", "code_information": [{"code": "AR-8956-45T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 491.75, "discounted_cash": 295.05, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.65, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 1322.2, "discounted_cash": 793.32, "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": 1322.2, "discounted_cash": 793.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTTLE SPRAY 16OZ PLASTIC TRIGGER SPRAY EMPTY STRL DISP", "code_information": [{"code": "32-410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.62, "discounted_cash": 26.77, "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": 1188.0, "discounted_cash": 712.8, "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": 1188.0, "discounted_cash": 712.8, "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 FOOT SUCTION 10FR", "code_information": [{"code": "130187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.18, "discounted_cash": 22.91, "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": 74.72, "discounted_cash": 44.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL TIP 11GA", "code_information": [{"code": "LS-278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 337.2, "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 FOR CEMENT MIXING W/ FEMORAL NOZZLE", "code_information": [{"code": "306-563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.85, "discounted_cash": 137.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING VACUUM VORTEX", "code_information": [{"code": "71270068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.77, "discounted_cash": 50.86, "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": "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", "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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.25, "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 BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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": 4620.0, "methodology": "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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 1301.0, "methodology": "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": 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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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 WHOLE HEALTH", "standard_charge_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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.06, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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", "standard_charge_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": 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": "BRIDGE ADJ 5.5MM SM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Nov-42", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4584.0, "discounted_cash": 2750.4, "setting": "both", "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": "BRIGADE HL 6X28X38 20DEG 7502100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7502100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15288.0, "discounted_cash": 9172.8, "setting": "both", "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": 30.22, "discounted_cash": 18.13, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 DIGIFUSE SYSTEM METASURG", "code_information": [{"code": "DF-2670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.9, "discounted_cash": 320.34, "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": 4000.0, "discounted_cash": 2400.0, "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": 550.0, "discounted_cash": 330.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 ALLERGY TESTS", "code_information": [{"code": "95070", "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "BRONCHOSCOPEBFLEXBFLEX 2 SLIM 3.8 SU (PACK OF 5) 0570-0448", "code_information": [{"code": "570-0448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.2, "discounted_cash": 437.52, "setting": "both", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2297.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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/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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "BROSELOW HINKLE PEDI ER KIT", "code_information": [{"code": "AE-4700", "type": "CDM"}], "standard_charges": [{"gross_charge": 5026.55, "discounted_cash": 3015.93, "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 BIOPSY G14919", "code_information": [{"code": "G14919", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2238.0, "discounted_cash": 1342.8, "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": 4.12, "discounted_cash": 2.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH STRYKER SERFAS 2.5 MM MICRO 279-250-201", "code_information": [{"code": "279-250-201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.42, "discounted_cash": 243.25, "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": 14.96, "discounted_cash": 8.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BSS 30ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0035", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 53.08, "discounted_cash": 31.85, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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 AIR INFULATOR BARCCO BLUE", "code_information": [{"code": "900404", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 40.52, "discounted_cash": 24.31, "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": 295.0, "discounted_cash": 177.0, "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": 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": 109.56, "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"}]}, 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{"payer_name": "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": 6074.0, "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": 123.15, "discounted_cash": 73.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON PROXIMAL TENODESIS REV 0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 943.08, "discounted_cash": 565.85, "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": 1000.0, "discounted_cash": 600.0, "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": 859.86, "discounted_cash": 515.92, "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": 310.02, "discounted_cash": 186.01, "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": 485.64, "discounted_cash": 291.38, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "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": 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": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC IDRL IMED LESN THRLMB", "code_information": [{"code": "63287", "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": "BX/EXC IDRL SPINE LESN CRVL", "code_information": [{"code": "63280", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC IDRL SPINE LESN LMBR", "code_information": [{"code": "63282", "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": "BX/EXC IDRL SPINE LESN SCRL", "code_information": [{"code": "63283", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC IDRL SPINE LESN THRC", "code_information": [{"code": "63281", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "BX/EXC XDRL SPINE LESN LMBR", "code_information": [{"code": "63277", "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": "BX/EXC XDRL SPINE LESN SCRL", "code_information": [{"code": "63278", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 295.0, "discounted_cash": 177.0, "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": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "C/M 16MM & 25MM PLUG WITH NOZZLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "32-8105-038-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 244.8, "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": 7004.0, "discounted_cash": 4202.4, "setting": "both", "billing_class": "facility"}]}, {"description": "C/M ULNA ASSEMBLY PLASMA SML RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-053-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "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 5 125MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71340011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4506.0, "discounted_cash": 2703.6, "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": 579.6, "discounted_cash": 347.76, "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": 1159.5, "discounted_cash": 695.7, "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": 170.41, "discounted_cash": 102.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE DOUBLE SS", "code_information": [{"code": "14-500056", "type": "CDM"}], "standard_charges": [{"gross_charge": 1859.48, "discounted_cash": 1115.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE DOUBLE TI", "code_information": [{"code": "14-500052", "type": "CDM"}], "standard_charges": [{"gross_charge": 1859.48, "discounted_cash": 1115.69, "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": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE FREQUENCY 300 CM HIGH W/ 8 MM PLUG STRL", "code_information": [{"code": "26006M-D/10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.36, "discounted_cash": 63.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE GUIDE LIGHT 4.25 MM 3M CF TYPE WA03310A", "code_information": [{"code": "WA03310A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.31, "discounted_cash": 706.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE MULTILEAD TRIAL", "code_information": [{"code": "3013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 338.4, "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": 28.75, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SINGLE SS", "code_information": [{"code": "14-500055", "type": "CDM"}], "standard_charges": [{"gross_charge": 1548.04, "discounted_cash": 928.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SINGLE TI", "code_information": [{"code": "14-500051", "type": "CDM"}], "standard_charges": [{"gross_charge": 1548.04, "discounted_cash": 928.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SNGL SINGLE BLOCKER WINTGRL CRIMP TITANIUM ALLOY ATLAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "826-213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.8, "discounted_cash": 663.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SUTURE LOOPED NYLON 20\" WHITE SIZE 3-0 SJAHEA3020", "code_information": [{"code": "SJAHEA3020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.74, "discounted_cash": 68.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SYSTEM BURN PROTECTION ES6107+", "code_information": [{"code": "ES6107+", "type": "CDM"}], "standard_charges": [{"gross_charge": 143.03, "discounted_cash": 85.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE TI STERILE W/CRIMP 1.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "498.800.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 674.4, "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": 864.0, "discounted_cash": 518.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE WITH CRIMP 1.7MM X 750MM - STERILE 298.801.01S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "298.801.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 674.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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"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 0DEG 25 X 11X 12MM 1108-0412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1108-0412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 5400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10 X 18 X 60MM 10 DEG", "code_information": [{"code": "C1713", 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[{"gross_charge": 29000.0, "discounted_cash": 17400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10MM B560-0710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B560-0710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2504-21410R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3168.0, "discounted_cash": 1900.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10MM INTERBODY 12 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-MD-1210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10MM X36MM X 8 DEGREES STAND ALONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX103608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 10X55 LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8712-5510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14860.0, "discounted_cash": 8916.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 11MM LORDOTIC TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TL1U11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 11MM MEDIUM TIJF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": 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"standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12 X 14 10 DEGREE 7H 490-1007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "490-1007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12 X 14 X 6MM 6 DEGREE 490-0605", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "490-0605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12 X 14 X 7MM 6 DEGREE 490-0607", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "490-0607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12 X 14 X 9MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100018-12149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12 X 22 X 55MM XLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "841260-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12D X 14W X 8H CERVICAL 50M-1214-08-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50M-1214-08-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM INTERBODY 12 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-MD-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM LORDOTIC TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TL1U12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM X 14MM X 8MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100018-12148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12X14MM 17-25MM 250-1214-17-25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "250-1214-17-25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27500.0, "discounted_cash": 16500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12X14X09MMX8 DEGREES CERVIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH121409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12X14X8MM INNER BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10018-12148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12X55 LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8712-5512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14860.0, "discounted_cash": 8916.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 13MM X 8 DEG 861-F3D-0830-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-0830-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 12 X 8MM 10 DEG 220-1008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-1008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 12 X 8MM 7DEG DC141208C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC141208C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 3831.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 12 X 9MM 10 DEG 220-1009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-1009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 16 X 6MM DC161406C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC161406C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 3831.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 16 X 7MM 10 DEG 22-1007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "22-1007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X 16 X 7MM FS-L07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS-L07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "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": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14.5 X 17 X 7 MM 6L 65-C-1517-7-6L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "65-C-1517-7-6L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3100.0, "discounted_cash": 1860.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14D X 16W X 8H 50A-1416-08-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50A-1416-08-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14MM X 15 DEGREESE MEDIUM SCARLET ALT SCA-LM 15 14-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LM 15 14-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30800.0, "discounted_cash": 18480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14MM X 16MM X 8MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100018-14168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14MM X 34MM X 6 DEG ALIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS143406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "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": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14X34X6 DEGREESE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB143406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 15DEG 22MM WIDE 14 X 50MM LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27024-1313S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16 X 14 X 7MM DC161407C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC161407C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 3831.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16 X 14 X 8MM DC161408C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC161408C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 3831.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16 X 14 X 8MM FS1614-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS1614-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16 X 14 X 8MM FS1614-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS1614-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16.5MM X 14MM CERVICAL 7 DEGREESE 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3CZ1614-0708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16.5MM X 14MM X 6MM 7 DEG 3CS1614-0706", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3CS1614-0706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16MM H, 36MM W, 14DEG MEDIUM FOOTPRINT STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX163614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 16X40X14 DEGREESE AX STAND ALONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX164014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 17 X 14 X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001106LL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 17 X 14 X 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001107LL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 17MM 22 X 30 X 17MM 15 DEGREE 3AF2230-1517", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-1517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18 X 45 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLB451007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26220.0, "discounted_cash": 15732.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18 X 50 X 8MM 6 DEGREE P11850-608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P11850-608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18 X 50 X 8MM, 6 DEGREE P11850-0608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P11850-0608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18 X 55 X 10MM 7 DEG L BOX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "XLB551007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27024-0079-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MM F3D LATERAL LUMBAR INTERBODY FUSION 3LL1845-0812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3LL1845-0812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MM X 45MM X 12MM 8 DEGREE FS18451208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS18451208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18W X 45L X 8H 8 DEG 62-1845-08-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-1845-08-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "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": 26220.0, "discounted_cash": 15732.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18X12X55 15 DEGREESE GA185512D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA185512D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 1MM 8 DEGREE 50-0830-11", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "50-0830-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54000.0, "discounted_cash": 32400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 30 X 13MM 15 DEGREE 3AF2230-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 30 X 14MM 15 DEGREE 3AF2230-1514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-1514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 30 X15MM 8 DEGREE 3AF2230-0815", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-0815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 45 X 10MM 8 DEG PLL2244-0810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLL2244-0810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 50 X 8H 12 DEGREE P12250-208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P12250-208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 55 X 10MM 8 DEG PLL2255-0810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLL2255-0810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22 X 60 X 12MM 7 DEGREE GB226012B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GB226012B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22MM 10MMX60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27024-0709-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8800.0, "discounted_cash": 5280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22MM X 45MM X 14MM 12 DEGREE LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC451412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22MM X 50MM X 12MM LATERAL 12 DEGRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC501212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22W X 45L X 8H 8 DEG 62-2245-08-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-2245-08-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22WX50LX10H 62-2250-10-14-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-2250-10-14-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22X 58X 12MM LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-50222-1258L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22X45X12MM LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FSC451207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22X45X8MM 7 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC450807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26220.0, "discounted_cash": 15732.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22X50X10MM 7 DEG LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FSC501007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22X55X12 12 DEGREESE LARDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC551212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 24MM X 30MM 14MM 8 DEG 861-F3D-0830-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-0830-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 24MM X 30MM X 12MM 8 DEG 861-F3D-1540-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-1540-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 24MM X 30MM X 14MM 15 DEG 861-F3D-1530-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-1530-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 25MM STAXX XD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CC11-1525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25200.0, "discounted_cash": 15120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 25MM X 11MM X 11MM 4 DEGREES ANYPLUS T-PLIF PEEK", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1108-0411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 5400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 26X10MM H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18.131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 30MM X 10MM X 11MM 3PS3010-0011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3PS3010-0011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290000.0, "discounted_cash": 174000.0, "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": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 34 X 26 X 13MM 8 DEGREE KA342613A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KA342613A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 35 X 25CM HII 13 DEGREE LORDOSIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LA1311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18938.4, "discounted_cash": 11363.04, "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": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 36X24X14HX12L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-MD1214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 38 X 26 X 14MM 12 DEGREE SA S3M382614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S3M382614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 38 X 28 X 13MM 8 DEGREE KA382813A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KA382813A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 38 X 28 X 15MM 20 DEGREE KA382815C", "code_information": [{"code": "KA382815C", "type": "CDM"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 38 X 28 X 17MM 15 DEGREE KA382817B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KA382817B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 38 X 36 X 16MM 12 DEG S3M383616", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S3M383616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "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": 5500.0, "discounted_cash": 3300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 40 X 27MM 12 DEG H 12MM ALIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-LG1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 40 X 27MM 12 DEG H 14MM ALIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-LG1214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 45MM X 12MM X 12 DEGREE INTERBODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC451212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5 DEGREE 10MM 100-092305-0710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092305-0710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22000.0, "discounted_cash": 13200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6 X 18 X 45MM 10 DEGREE 101-06184510-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-06184510-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8132.4, "discounted_cash": 4879.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6 X 22 X 50MM 10 DEGREE 101-06225010-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-06225010-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8132.4, "discounted_cash": 4879.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6 X 22 X 50MM 10 DEGREESE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-06225010-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19300.0, "discounted_cash": 11580.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 60 X 21 X 10 8DEG LATERAL", "code_information": [{"code": "JLT-M8 60 10-S", "type": "CDM"}], "standard_charges": [{"gross_charge": 31200.0, "discounted_cash": 18720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 60 X 21 X 10 LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JLT-MB 60 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31200.0, "discounted_cash": 18720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6DEG 40MM X 27MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-LG0612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MM ACF.12140706", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACF.12140706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40000.0, "discounted_cash": 24000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MM LARGE CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCL0706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MM LARGE CERVICAL.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZLCL0706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MM X 14MM X 12MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NC651412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM ACF.12140707", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACF.12140707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40000.0, "discounted_cash": 24000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM CERVICAL.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZLCL0707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM F3D-Z 910-0607", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "910-0607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14000.0, "discounted_cash": 8400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM X 14MM X 12MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NC751412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM X 16MM X 14MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NC751614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8 X 18 X 45MM 10 DEGREE 101-08184510-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-08184510-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8132.4, "discounted_cash": 4879.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM B37-CL-4208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B37-CL-4208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM B560-0509", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B560-0509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2504-21408R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3070.0, "discounted_cash": 1842.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM F3D CURVED 28 X 10MM 3TF2810-0008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3TF2810-0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM LARGE CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZLCL0708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM LORDOTIC JULLET TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JUT-T6 30 08-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23000.0, "discounted_cash": 13800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM X 11MM X 14MM 7 DEG CVA-081114-D7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CVA-081114-D7H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40000.0, "discounted_cash": 24000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM X 14MM SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NC851412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9 X 22 X 11MM NEXT ORTHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CABB220911A-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9 X 26 X 10MM 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BB092610A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9 X 26 X 9.5-14 10 DEG EXPANDABLE BH092609D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BH092609D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31000.0, "discounted_cash": 18600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM 7 DEGREE ACF 12140709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACF 12140709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM B20-0609", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B20-0609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2504-21409R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1584.0, "discounted_cash": 950.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM F3D CURVED 28 X 10MM 3TF2810-0009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3TF2810-0009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM PARALLEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-72000-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4186.0, "discounted_cash": 2511.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE A BOX 16 X 34 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB163412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE A-BOX 12MM X 34MM X 6 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB123406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 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B10-C3215-15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B10-C3215-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13020.0, "discounted_cash": 7812.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 32 X 21 X 12MM 12 DEGREE S3M322112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S3M322112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 32 X 21 X 14MM 12 DEGREE S3M322114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S3M322114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 34 X 26 X 15MM 15 DEGREE KA342615B", "code_information": [{"code": 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X 35MM 15DEG 3AS2535-1515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF M3 STAND-ALONE 27 X 40 X 14MM 15 DEGREE 3AS2740-1514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2740-1514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33000.0, "discounted_cash": 19800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF PEEK H11MM 13 DEG 41MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XA1311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF PEEK H13MM 13 DEG 41MM X 28MM", 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"LA0713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF SA 35 X 25 X 10MM 12 DEGREE S3M352510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S3M352510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF TITANIUM 22X30X10MM 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-0810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF VAULT 32MM X 15MM X 15-DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C3215-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5440.0, "discounted_cash": 3264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANT CERV 12MM X 14MM X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13.4405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANT CERV 12MM X 14MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13.4406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANT CERV PEEK 10DEG 20MM X 16MM X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13.4215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANT CERV PEEK 6 DEG 12MM X 14MM X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13.4115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANT CERV PEEK 6 DEG 12MM X 14MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13.4116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ASSY 12MM X 30MM X 14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX123014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ASSY 14MM X 30MM X 8 HA PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX143008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "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": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE AX ALIF 16MM X 36MM X 08 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX163608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE AXT. 16 X 30MM 8 DEGREE AXTI163008", "code_information": [{"code": "C1713", "type": "HCPCS"}, 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"standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE C-FUSE 14 X 12 X 7MM CERVICAL INT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C1412-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE C-FUSE 18 X 14 X 7MM CERVICAL INT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C1814-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CANCELLOUS 14 X 16 X 7 59-141607", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "59-141607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CAVETTO 14 X 16 X 9MM CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100018-14169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERFICAL PEEK 14 X 12 X 8MM DA141208C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DA141208C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERFICAL PEEK 14 X 16 X 7MM DA161407C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DA161407C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZLCL0710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 11MM X 14MM X 7MM 7DEG LORDOTIC CRUCIFORM PEEK CALIX IMP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "X003-0007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 11MM X 14MM X 8MM 7DEG LORDOTIC CRUCIFORM PEEK CALIX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "X003-0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 11MM X 14MM X 8MM CRUCIFORM CONVEX PEEK CALIX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "X003-0108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 11MM X 14MM X 9MM 7DEG LORDOTIC CRUCIFORM PEEK CALIX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "X003-0009C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 11MM ZLCL0711", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "ZLCL0711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 12D X 14W X 6H NEXXT MATRIXX 50M-1214-06-SP", 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7H 52N-1215-07-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52N-1215-07-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18200.0, "discounted_cash": 10920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL-X 5MM PD-31-204", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PD-31-204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5500.0, "discounted_cash": 3300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICLE 7 DEGREE 11MM X 14MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-SM0706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CONVEX CERVICAL 14D X 16W X 7H 50A-1416-07-SP", "code_information": [{"code": "C1713", 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"setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CXHA 12MM X 14MM X 10MM X 8 DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH121410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 4260.0, "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": 7100.0, "discounted_cash": 4260.0, "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": 7100.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ENCLAVE PEEK 14MM X 12MM X 18MM 14DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-530494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE EPIPHANY 55MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PSL55-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22000.0, "discounted_cash": 13200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE EXPANDABLE 12DEG 22MM X 9MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CC11-1750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25200.0, "discounted_cash": 15120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE EXTERIOR 30-40MM DCS-12T50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DCS-12T50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 6000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE F3D 22MM X 30MM X 10MM 15DEGREE 3AF2230-1510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-1510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE F3D 22MM X 30MM X 11MM 15DEGREE 3AF2230-1511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2230-1511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE F3D ALIF 25MM X 35MM X 12MM 8DEGREE 3AF2535-0812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": 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"type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29000.0, "discounted_cash": 17400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION 10 MM LORDOTIC LARGE CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCL0710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION 3D ALIF STAND-ALONE 8 DEGREE - 25MM X 35MM X 10MM 3AS2535-0810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION ANT LUMBAR 19MM X 25MM X 35MM - 13 DEGREE LA1319", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LA1319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18000.0, "discounted_cash": 10800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION LUMBAR 11MM X 10MM X 30MM PL3011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL3011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 8640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION LUMBAR 13MM X 10MM X 26MM PM2613", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PM2613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 8640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION LUMBAR 13MM X 10MM X 30MM PL3013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL3013", "type": "CDM"}, {"code": "278", 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"setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FUSION 10MM INTERBODY PEEK NEUTRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-05000-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 8100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE GALAXY CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC751614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE HA PEEK 22 X 55 X 10MM 7DEG GA225510B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA225510B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE HA PEEK 22 X 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"C1713", "type": "HCPCS"}, {"code": "AX143014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29849.6, "discounted_cash": 17909.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE INFERIOR 30-40MM DCS-22T50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DCS-22T50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 6000.0, "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": 13050.0, "discounted_cash": 7830.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE INTERBODY 14 X 16 X 08MM 8 DEGREE 59-141608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "59-141608", "type": "CDM"}, 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"facility"}]}, {"description": "CAGE LAT 10MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8712-4510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14860.0, "discounted_cash": 8916.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LAT 10MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8712-5010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14860.0, "discounted_cash": 8916.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LAT 8MM X 22MM X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8222-6008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12272.0, "discounted_cash": 7363.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 10 X 58 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IM50052-23", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11376.0, "discounted_cash": 6825.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 12MM 3LL1855-1212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3LL1855-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29000.0, "discounted_cash": 17400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 18W X 50L X 8H 8 DEG 62-1850-08-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-1850-08-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 18W X 55L X 8H 8 DEG 62-1855-08-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-1855-08-8-SP", "type": "CDM"}, 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"setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 22 X 50 X 12MM X 7 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC501207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 22 X 50 X 8MM X 7 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLC500807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18000.0, "discounted_cash": 10800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 22 X 55 X 10 8 DEGREE LXL22105508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LXL22105508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, 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"both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR 28 X 10X 11MM 6DEG JIR-O6 28 11-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JIR-O6 28 11-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23000.0, "discounted_cash": 13800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR 9MM X 10MM X 26MM FOUNDATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PM2609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ALIF 10DEG P26 H12 PEEK DYA-10 26 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DYA-10 26 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ALIF 10DEG P26 H14 PEEK DYA-10 26 14-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DYA-10 26 14-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ALIF 5DEG P26 H12 PEEK DYA-05 26 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DYA-05 26 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ALIF 5DEG P26 H14 PEEK DYA-05 26 14-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DYA-05 26 14-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ANTERIOR SMALL 15 DEG SCA-LS 15 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LS 15 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30800.0, "discounted_cash": 18480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR LATERAL L45 H10 PEEK JUL-LL 45 10-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JUL-LL 45 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR LATERAL L45 H12 PEEK JUL-LL 45 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JUL-LL 45 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR LATERAL L50 H12 PEEK JUL-LL 50 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JUL-LL 50 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR LATERAL L50 H14 PEEK JUL-LL 50 14-S", "code_information": [{"code": "JUL-LL 50 14-S", "type": "CDM"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR TRANSFORAMINAL L30 W10.5 H11 6DEG JUT -T6 30 11-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JUT -T6 30 11-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23000.0, "discounted_cash": 13800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND -ALONE ALIF 25MM X 35MM X 10MM 15DEGREE 3AS2535-1510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND ALONE ALIF 25 X 35 X 12MM 8 DEGREE 3AS2535-0812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND ALONE ALIF 27MM X 40MM 15DEG (15MM) 3AS2740-1515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2740-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90000.0, "discounted_cash": 54000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND ALONE ALIF 27MM X 40MM 15DEG 12MM 3AS2740-1512", "code_information": 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"code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3AS2535-0814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND-ALONE ALIF 25MM X 35MM 8DEG 3AS2535-0811", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33000.0, "discounted_cash": 19800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND-ALONE ALIF 25MM X 35MM X 11MM 15 DEGREE 3AS2535-1511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND-ALONE ALIF 25MM X 35MM X 16MM 8DEG 3AS2535-0816", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE M3 STAND-ALONE ALIF 27 X 40 X 12MM 8 DEGREE 3AS2740-0812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2740-0812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33000.0, "discounted_cash": 19800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE MEDIUM H14 10DEG SCARLET ANT SCA-LM 10 14-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LM 10 14-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30800.0, "discounted_cash": 18480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE METAL-POLYMER AX 14 X 40 X 14MM AX144014", 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"BB092811A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE OTLIF EXPANDABLE 9 X 24 X 9.5 10 DEG BH092409D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BH092409D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31000.0, "discounted_cash": 18600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE OTLIF EXPANDABLE 9 X 26 X 9.5 10 DEG BH092612E", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BH092612E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31000.0, "discounted_cash": 18600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PAK 22 X 60 X 12MM 20 DEG LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86126012", "type": "CDM"}, {"code": 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{"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PLIF 9MM 8 DEGREE PIP.26100809", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45400.0, "discounted_cash": 27240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PLIF TITANIUM 28 X 9 X 11MM P3L280911", "code_information": [{"code": "P3L280911", "type": "CDM"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PLIF TITANIUM 28 X 9 X 9MM P3L280909", "code_information": [{"code": "P3L280909", "type": "CDM"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PLIF TITANIUM 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{"code": "SCA-LS 10 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30800.0, "discounted_cash": 18480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPACER 12 X 8 X 14MM LORDOTIC CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15-4608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPACER 12 X 8 X 7MM LORDOTIC CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15-4607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL 12MM X 55MM X 22MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8722-5512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12272.0, "discounted_cash": 7363.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL 14MM X 28MM X 6DEG A BOX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB142806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 14340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL 30MM X 25MM X 12MM 12DEG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P14025-212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11500.0, "discounted_cash": 6900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL 32MM X 15MM X 11MM PEEK VAULT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C3215-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 7440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL 8X14X12MM 6 220-0608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-0608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL DIST WRENCH TIP KEY", "code_information": [{"code": "25909", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1410.0, "discounted_cash": 846.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL PLIF 10 X 10 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PM2610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 8640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL SM 14MM X 11MM X 7MM 0 DEGREE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CSTS-SM0007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104348.0, "discounted_cash": 62608.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL STRAIGHT 30MM X 10MM X 0DEG 12MM FOUNDATION 3D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3PS3010-0012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29000.0, "discounted_cash": 17400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL STRAIGHT 36MM X 10MM X 0DEG 13MM FOUNDATION 3D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3PS2610-0013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29000.0, "discounted_cash": 17400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINAL TLIF 10 X 12 X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL3012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 8640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 12 X 40 X 12MM A-BOX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB124012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 14340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 12MM X 34MM X 12 DEG A-BOX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB123412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 14340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 14 X 40 X 6MM A-BOX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB144006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 14340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 18 X 55 X 10 12DEG MEDIUM LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "831255-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 18 X 55 X 12 12DEG MEDIUM LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "831255-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 22X55MM 7 DEG LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FSC551007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE EXTREME 10 X 22 X 55MM 15DEG LATERAL INTERBODY FUSION PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7151055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16530.0, "discounted_cash": 9918.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE LUCENT TI-BOND INTERBODY LATEX FREE PEEK TITANIUM POROUS COATING CURVED LUMBAR STERILE DI", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P11227-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE TPLIF 28 X 11 X 10MM 4 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1148-0410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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"setting": "both", "billing_class": "facility"}]}, {"description": "CAGE STAND-ALONE ALIF M3 25MM X 35MM X 13MM 15 DEGREE 3AS2535-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE STAND-ALONE M3 25MM X 35MM X 13MM 8 DEGREE 3AS2535-0813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE STAND-ALONE M3 25MM X 35MM X 15 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE STANDARD 25 X 9 X 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-1551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12670.0, "discounted_cash": 7602.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE T TALOS 10 X 28 X 6 DEGREE 2-21109-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-21109-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14200.0, "discounted_cash": 8520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TALOS 12 X 14MM 8 HOLE 5-21208-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-21208-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TALOS 12X14X140 8H 5-21208-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-21208-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TALOS 9MM 5-21209-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-21209-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TETRAFUSE CERVICAL 12MM X 14MM X 6MM 6 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "65-C-1214-6-6L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3100.0, "discounted_cash": 1860.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TETRAFUSE LATERAL 18MM X 55MM X 11MM 6 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "65-L-1855-11-6L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9900.0, "discounted_cash": 5940.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI 18 X 55 X 10MM 7 DEGREE GB185510B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GB185510B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI 22 X 55 X 10MM 7 DEGREE GB225510B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GB225510B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI-LIFE LATERAL L50 W21 H10 8DEG JLT-M8 50 10-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JLT-M8 50 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI3Z INTERBODY SYSTEM ZAVATION 230-0927-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "230-0927-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33000.0, "discounted_cash": 19800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 10 X 30 X 10MM BA103010B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BA103010B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 11 X 25MM STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-05000-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 8100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 11MM 4 DEGREE PIP.26100411", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9500.0, "discounted_cash": 5700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 11MM B570-092705-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B570-092705-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12 LEVEL FS01-05004-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS01-05004-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12 X 25MM STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-05000-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 8100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12MM - 4 DEGREE PIP.26100412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34050.0, "discounted_cash": 20430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12MM 4 DEGREE PLA1412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLA1412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12MM 8 DEGREE PIP.26100812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34050.0, "discounted_cash": 20430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 12MM B570-092705-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B570-092705-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 13MM 4 DEGREE PIP.26100413", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50000.0, "discounted_cash": 30000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 13MM 8 DEGREE PIP.26100813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.26100813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 13MM B570-092705-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B570-092705-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 14MM - 4 DEGREE PIP.22100414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PIP.22100414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 14MM B570-092705-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B570-092705-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 25MM FS-01-05004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS-01-05004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 26X9MM PEEK INTERBODY H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18.1309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 8 X 18 X 55MM 10 DEGREE 101-08185510-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-08185510-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8132.4, "discounted_cash": 4879.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 8MM TITANIUM 30MM X 11MM T3301108", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T3301108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 8MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TM2508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18492.0, "discounted_cash": 11095.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 9 X 27 X 5 DEGREE 10MM B570-092705-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B570-092705-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 9MM TITANIUM T3301109", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T3301109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF 9MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TM2509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 8640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF LORDOTIC 12MM 2-21112-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-21112-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF LORDOTIC 7MM 2-21107-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-21107-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14200.0, "discounted_cash": 8520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF LORDTIC 11MM 2-21111-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-21111-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF PEEK 26X11 8 DEG CEZANNE-II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18.1311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF TALOS 10MM 2-21110-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-21110-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF TITANIUM 9MM T3L321109", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T3L321109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "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": 16000.0, "discounted_cash": 9600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TRUSS TITANIUM SMALL 0 DEG 14MM X 11MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-SM0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TX HA 10W X 10H X 28L X 5 TX10102805", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TX10102805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "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": 16800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE VEGASPAN 16 X 43", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-61002-1643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15780.0, "discounted_cash": 9468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE WIDE 13MM X 18MM X 10MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "3608-210133W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12460.0, "discounted_cash": 7476.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE X-CORE 2 TI 22 X 24-33", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7220033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20690.0, "discounted_cash": 12414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE XLIF 10 X 22 X 50MM LATERAL FOUNDATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "841250-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24000.0, "discounted_cash": 14400.0, "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": 30800.0, "discounted_cash": 18480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGEINTERBODY 10MM X 22MM X 55MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8722-5510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12272.0, "discounted_cash": 7363.2, "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": 12460.0, "discounted_cash": 7476.0, "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": 12460.0, "discounted_cash": 7476.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGES PLIF PARALLEL 11MM X 27MM X 9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-112700-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 6000.0, "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": 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"standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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 CARBONATE 500 MG CHEW TAB", "code_information": [{"code": "MED0729", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCIUM CHLORIDE 10% 10ML", "code_information": [{"code": "MED0050", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.07, "discounted_cash": 16.84, "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": 41.26, "discounted_cash": 24.76, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.68, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.86, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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historical data found for payer/plan and coding combination", "standard_charge_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": 2300.0, "discounted_cash": 1380.0, "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": 226.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 1-4MM 10CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "53021-1-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "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": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 20CC 600-04-0300", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "600-04-0300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 30CC 1-4MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "53021-1-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 30MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PBC-1430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 4 X 10MM 30CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "53021-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS CRUSHED 1-4MM 15CC CCH-1415", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CCH-1415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CRUSHED 1-4MM 30CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "306 Allograft", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CUBE 14X14X14MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DCB-10014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.53, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 8450.0, "methodology": "fee 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 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 55.77, "discounted_cash": 33.46, "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 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{"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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", "standard_charge_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": 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 NAVIGATION ENT CRANIAL MAP EXPRESS", "code_information": [{"code": "6001-655-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2359.16, "discounted_cash": 1415.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARD NAVIGATION LG ORTHO", "code_information": [{"code": "6003-640-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 461.13, "discounted_cash": 276.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CARD NAVIGATION MED ENT EAR NOSE THROAT", "code_information": [{"code": "6001-651-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.46, "discounted_cash": 1421.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CARD NAVIGATION MED ORTHO", "code_information": [{"code": "6003-640-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.79, "discounted_cash": 721.07, "setting": "both", "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", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 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": 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": 4620.0, "methodology": "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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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", 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"both", "billing_class": "facility"}]}, {"description": "CARTRIDGE MEDISORB CO2 ABSORBER 427000100", "code_information": [{"code": "427000100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.81, "discounted_cash": 47.89, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE NDLINJECTOR II", "code_information": [{"code": "CAT01857", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.95, "discounted_cash": 497.37, "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": 273.94, "discounted_cash": 164.36, "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": 150.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 12MM 60MM GOLD LAP TROCAR RLD FOR ECHELON 60 ENDOPATH STAPLER EC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.7, "discounted_cash": 146.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 12MM 60MM GRN LAP TROC RLD ECHELON ENDOPATH LF STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 144.0, "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": 20.97, "discounted_cash": 12.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 60MM WHT RLD LAPARASCOPIC W/ ENDOCUTTER ECHELON ENDOPATH LF STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.66, "discounted_cash": 135.4, "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": 634.88, "discounted_cash": 380.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT WHT SHOUDLER MAGNUMWIRE ULTRA HIGH TENSILE STRENGTH SUT. COMPATIBL", "code_information": [{"code": "OM-8085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 211.2, "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": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CASE ACCESSORY PATIENT CASEA10E", "code_information": [{"code": "CASEA10E", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": "CASSETTE CORE IRRIGATION", "code_information": [{"code": "5400050001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.53, "discounted_cash": 81.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST PADDING WEBRIL 3 INCH NC", "code_information": [{"code": "MDS066003Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 3.07, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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": 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": 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": 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": "CATH FOLEY 12FR 2W 5CC (REPL 0165SI12)", "code_information": [{"code": "175812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.61, "discounted_cash": 11.77, "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": 23.17, "discounted_cash": 13.9, "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": 17.02, "discounted_cash": 10.21, "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": 20.01, "discounted_cash": 12.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH GLIDECATH J-TIP 5FR CG504", "code_information": [{"code": "CG504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV AUTOGUARD INSYTE 18GX1.16 381444", "code_information": [{"code": "381444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "discounted_cash": 5.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV AUTOGUARD INSYTE 22GX1.00 381423", "code_information": [{"code": "381423", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.81, "discounted_cash": 5.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV AUTOGUARD INSYTE 24GX0.75 381412", "code_information": [{"code": "381412", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.08, "discounted_cash": 5.45, "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": 32.72, "discounted_cash": 19.63, "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 RED ROB 22F 56122", "code_information": [{"code": "56122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SUCTION 8FR DELEE TIP STRT", "code_information": [{"code": "DYND41908", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHATER VORTEX TR PORT 9.6 SPDX-16-1", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "SPDX-16-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1722.0, "discounted_cash": 1033.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 10FR CLEAN-CATH VINYL", "code_information": [{"code": "421710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 16FR SILICONE 3-WAY 5ML", "code_information": [{"code": "E716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.82, "discounted_cash": 4.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 5CC 22FR COUDE TIP BRD0168L22H", "code_information": [{"code": "BRD0168L22H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.54, "discounted_cash": 24.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 7FR X 7CM X 60CM CF7-7-60", "code_information": [{"code": "C1888", "type": "HCPCS"}, {"code": "CF7-7-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2633.5, "discounted_cash": 1580.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 8 FR RED RUBBER", "code_information": [{"code": "87-660085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.48, "discounted_cash": 2.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 8FR CLEAN-CATH VINYL", "code_information": [{"code": "421708", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ANGEOGRAPIC .038IN 5FR 80CM VISCERAL TORCON NB ADVANTAGE", "code_information": [{"code": "G13560", "type": "CDM"}], "standard_charges": [{"gross_charge": 74.4, "discounted_cash": 44.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ANGEOGRAPIC .038IN 5FR 80CM VISCERAL TORCON NB ADVANTAGE BEACON", "code_information": [{"code": "G13561", "type": "CDM"}], "standard_charges": [{"gross_charge": 74.4, "discounted_cash": 44.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ANGEOGRAPIC 5FR 65 CM .035IN VISCERAL ANGIOGRAPHIC TORCON NB ADVANTAGE", "code_information": [{"code": "G08442", "type": "CDM"}], "standard_charges": [{"gross_charge": 74.4, "discounted_cash": 44.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ANGEOGRAPIC 5FR 65 CM .038IN ANGLED MULTIPURPOSE ADVANTAGE TORCON NB", "code_information": [{"code": "G09362", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.56, "discounted_cash": 45.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ANGIOGRAPHY .035IN 5FR .044IN 100 CM NON BRAIDED SIMMONS CVD SOFTTOUCH", "code_information": [{"code": "5564-F3", "type": "CDM"}], "standard_charges": [{"gross_charge": 51.15, "discounted_cash": 30.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BALLOON GASTRIC SUCTION", "code_information": [{"code": "B-2020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.72, "discounted_cash": 278.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN STANDARD SILICONE", "code_information": [{"code": "890923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.01, "discounted_cash": 63.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CHOLANGIOGRAPHY 2.5MM", "code_information": [{"code": "G27848", "type": "CDM"}], "standard_charges": [{"gross_charge": 117.15, "discounted_cash": 70.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CLOSUREFAST RF 6F-60CM CF6-8-60", "code_information": [{"code": "C1888", "type": "HCPCS"}, {"code": "CF6-8-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2644.95, "discounted_cash": 1586.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 14 FR MALECOT FOUR WING LATEX DISP", "code_information": [{"code": "86014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.06, "discounted_cash": 30.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 16FR MALECOT FOUR WING LATEX DISP", "code_information": [{"code": "86016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.06, "discounted_cash": 30.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 32FR MALLECOT FOUR WING LATEX DISP", "code_information": [{"code": "86032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.06, "discounted_cash": 30.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 34FR MALLECOT FOUR WING LATEX", "code_information": [{"code": "86034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.06, "discounted_cash": 30.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DUPLOCATH APPLICATION 35CM 1506166", "code_information": [{"code": "1506166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.88, "discounted_cash": 102.53, "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": 209.8, "discounted_cash": 125.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 19GA X 14IN SOFT TIP HVY DTY BODY BREVI-KATH", "code_information": [{"code": "155-2393", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.77, "discounted_cash": 140.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 19GA X 845MM SPINAL RADIO OPAQUE WIRE WOUNDINSULATED TUN-L-XL", "code_information": [{"code": "155-2540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.16, "discounted_cash": 143.5, "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": 213.6, "discounted_cash": 128.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 21GA X 24IN RADIO OPAQUE SPRING WOUND STYLETTED W/ STYLET EPI NDL V", "code_information": [{"code": "156-2124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.05, "discounted_cash": 126.63, "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": 110.05, "discounted_cash": 66.03, "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": 507.49, "discounted_cash": 304.49, "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": 444.28, "discounted_cash": 266.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 7.5FR 15MM TO 18MM 240 CM 5.5 CM PYLORIC COLONIC WIRE GUIDED", "code_information": [{"code": "M00558490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.64, "discounted_cash": 300.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 7.5FR 18MM TO 20MM 240 CM 5.5 CM COLONIC WIRE GUIDED BLLN DI", "code_information": [{"code": "M00558500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.64, "discounted_cash": 300.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEL 6FR 12MM TO 15MM 180CM 8 CM PYLORIC FIXED", "code_information": [{"code": "M00558361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.28, "discounted_cash": 266.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESPH PYL 7.5FR 10-12MM 240CM 5.5CM GW NONVASCULAR", "code_information": [{"code": "M00558470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.64, "discounted_cash": 300.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESPH PYL 7.5FR 12-15MM 240CM 5.5CM GW NONVASCULAR", "code_information": [{"code": "M00558480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.64, "discounted_cash": 300.98, "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": 583.08, "discounted_cash": 349.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FLUSH 5FR .052IN X .035IN 90 CM PIGTAIL 10 SIDE PORT SOFTTOUCH", "code_information": [{"code": "5539-91", "type": "CDM"}], "standard_charges": [{"gross_charge": 51.15, "discounted_cash": 30.69, "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": 31.17, "discounted_cash": 18.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 12FR 5CC COUDE TIP 2 WAY", "code_information": [{"code": "168L12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.31, "discounted_cash": 24.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 14FR 5CC COUDE TIP 2 WAY CARSON", "code_information": [{"code": "168L14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.55, "discounted_cash": 25.53, "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": 55.89, "discounted_cash": 33.53, "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": 27.49, "discounted_cash": 16.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5 ML URETHRAL 2 WAYINFECTION CONTROL HYDROGEL SILVER LATEX B", "code_information": [{"code": "165SI16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.72, "discounted_cash": 21.43, "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": 20.01, "discounted_cash": 12.01, "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": 19.09, "discounted_cash": 11.45, "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": 47.27, "discounted_cash": 28.36, "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": 54.22, "discounted_cash": 32.53, "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": 20.01, "discounted_cash": 12.01, "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": 47.27, "discounted_cash": 28.36, "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": 34.39, "discounted_cash": 20.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 16FR 5CC 2-WAY 0168L16", "code_information": [{"code": "168L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.34, "discounted_cash": 24.2, "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": 40.34, "discounted_cash": 24.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 20FR 5ML 2-WAY 0168L20", "code_information": [{"code": "168L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.54, "discounted_cash": 24.32, "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": 40.14, "discounted_cash": 24.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 24FR 5CC 2-WAY 0168L24", "code_information": [{"code": "168L24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.14, "discounted_cash": 24.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE LATEX 14FR 10ML DYND11214", "code_information": [{"code": "DYND11214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.15, "discounted_cash": 3.69, "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": 435.55, "discounted_cash": 261.33, "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": 9.2, "discounted_cash": 5.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 18GA X 1 16/100IN GRN SHIELDED 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 5.85, "discounted_cash": 3.51, "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": 27.22, "discounted_cash": 16.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFOTAXIME (CLAFORIN) 1GM INJ", "code_information": [{"code": "MED0055", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.96, "discounted_cash": 4.18, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 8450.0, "methodology": "fee 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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11.5X14.5X11 MM 7DEG 2504-21411L", "code_information": [{"code": "2504-21411L", "type": "CDM"}], "standard_charges": [{"gross_charge": 3500.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL ASSEMBLED CORTICO-CANCELLOUS 11.5X14.5X8 MM 0DEG 2504-21408P", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2504-21408p", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3168.0, "discounted_cash": 1900.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL ASSEMBLED CORTICO-CANCELLOUS 11.5X14.5X8 MM 7DEG 2504-21408L", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2504-21408L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3500.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL ASSEMBLED CORTICO-CANCELLOUS 11.5X14.5X9 MM 7DEG 2504-21409L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2504-21409L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3500.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL CAGE 7MM STRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-MD20007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL CAGE FOUNDATION 3D 14.5MM X 12MM X 7MM X 7DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3CF1412-0707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "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": 14477.0, "discounted_cash": 8686.2, "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": 7006.86, "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": 6074.0, "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": 2123.0, "discounted_cash": 1273.8, "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": 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": 1322.0, "discounted_cash": 793.2, "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": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL PEEK CIF 6 DEG -07", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "20-0607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 6MM 7 DEGREE 21411-706", "code_information": [{"code": "21411-706", "type": "CDM"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 6MM 7 DEGREE POROUS COATED P21411-706", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P21411-706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 7MM 7 DEGREE POROUS COATED P21411-707", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "p21411-707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 8MM 7 DEGREE 21411-708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21411-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 8MM 7 DEGREE POROUS COATED P21411-708", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "p21411-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY 14 X 11 X 9MM 7 DEGREE POROUS COATED P21411-709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P21411-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY LARGE 16 X 13 X 7MM 7 DEGREE POROUS COATED P21613-707", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P21613-707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY LARGE 16 X 13 X 8MM 7 DEGREE POROUS COATED P21613-708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "p21613-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL PEEK INTERBODY LARGE 16 X 13 X 9MM 7 DEGREE POROUS COATED P21613-709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P21613-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "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": 177104.42, "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, "estimated_discounted_cash": 173612.2, "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 SPINE TRUSS 17 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-MD0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL VISUALIZATION HARNESS", "code_information": [{"code": "PD-33-600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 418.75, "discounted_cash": 251.25, "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": 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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2827.0, "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": 161.51, "discounted_cash": 96.91, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.91, "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": "CGT IMPLANT SIXE 40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CGT-40T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3612.0, "discounted_cash": 2167.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CHAMBER DOMINO 3 SH0031", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SH0031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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 NEPHROURETERAL CATH", "code_information": [{"code": "50387", "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": 2297.0, "methodology": "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": 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": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51705", "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "CHANNEL BONE NANO FX PLEURISTIKINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FURS-2001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 338.4, "setting": "both", "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": 1800.0, "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": 702.5, "discounted_cash": 421.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM PRODIGY NEURO STIMULATOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2524.3, "discounted_cash": 1514.58, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "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 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 1-5", "code_information": [{"code": "64646", "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": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 562.89, "maximum": 8450.0, "gross_charge": 1163.0, "discounted_cash": 697.8, "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": 562.89, "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);EXTREMITY(S) AND/OR TRUNK MUSCLE(S) 64614", "code_information": [{"code": "1480258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2123.0, "discounted_cash": 1273.8, "setting": "both", "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": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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": 2123.0, "discounted_cash": 1273.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES 64644", "code_information": [{"code": "64644", "type": "CPT"}, {"code": "18370595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.77, "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", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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, "estimated_discounted_cash": 7056.63, "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", "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"}], "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": "CHIP BONE 10CC ALPHA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "67013-210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "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": 3600.0, "discounted_cash": 2160.0, "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": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIPS ALLOGRAFT CANCELLOUS 30CC OSCC2003-30", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "OSCC2003-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "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 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.58, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.75, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 44.11, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.84, "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": 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": 7.2, "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": 17.95, "discounted_cash": 10.77, "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", "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": 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": 2411.0, "maximum": 9357.0, "gross_charge": 7698.0, "discounted_cash": 4618.8, "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": 3725.83, "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": 2540.34, "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": "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": 7698.0, "discounted_cash": 4618.8, "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 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": 3725.83, "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. 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{"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": 33.52, "discounted_cash": 20.11, "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 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"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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.85, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.24, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.93, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.84, "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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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"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": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1827.1, "methodology": "fee schedule"}, {"payer_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 -07 20-1007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-1007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIF 10 DEG -08 20-1008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-1008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 3960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIF 6 DEG -08 20-0608", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20-0608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIF 6 DEG -09 20-0609", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20-0609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIF 6 DEG -11 20-0611", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-0611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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 TISSUE WHIPKNOT SZ 5.0 3.8M SOFT ARTHROSCOPY CANNULA", "code_information": [{"code": "7211015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.48, "discounted_cash": 138.29, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 596.77, "discounted_cash": 358.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/CILOXAN OPHTHALMIC", "code_information": [{"code": "MED0060", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.07, "discounted_cash": 6.04, "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": 596.77, "discounted_cash": 358.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA 72IN 3LT BAG BREATHING UNIVERSAL FLEX 2 ADLT", "code_information": [{"code": "DF375-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.02, "discounted_cash": 16.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA PEDI F2", "code_information": [{"code": "DYNJAPF6002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.55, "discounted_cash": 20.13, "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": 27.08, "discounted_cash": 16.25, "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": 34.62, "discounted_cash": 20.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 60IN UNILIMB LF 3L BAG SAMPLE PORT LINE ADULT", "code_information": [{"code": "DYNJAAF6390", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.68, "discounted_cash": 24.41, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 60IN UNIVSL ANES COAX W/ GAS SAMPLE PORT ELBOW AND FILTER AND", "code_information": [{"code": "D360-61Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.86, "discounted_cash": 10.72, "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": 36.05, "discounted_cash": 21.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BRTHG PORT LN BG MSK 60IN ADLT 3L NS LF UNV F2 LG", "code_information": [{"code": "D366-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.66, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT RESPIRATORY 90IN ADLT ANESTHESIA EXPANDABLE TUBING", "code_information": [{"code": "CHAXX9005B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.68, "discounted_cash": 19.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT UNIVERSAL ANESTHESIA ADULT GAS SAMPLING MASK SZ6 60IN", "code_information": [{"code": "DYNJAAF6510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.94, "discounted_cash": 21.56, "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": 55.38, "discounted_cash": 33.23, "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 NEONATE", "code_information": [{"code": "54160", "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": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "CIRCUT CROSS VENT ADULT", "code_information": [{"code": "80011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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": 605.0, "discounted_cash": 363.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 224.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.45, "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 ARTICULATING SIDEKICK SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RRTM0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1460.0, "discounted_cash": 876.0, "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": 548.67, "discounted_cash": 329.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP INSTRUMENT ELECTROMAGNETIC SPHERE 8000-060-020", "code_information": [{"code": "8000-060-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4912.05, "discounted_cash": 2947.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP INTERSPINOUS 10MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1-61007-1037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP JET-X 40DEG 46 X 23 X 39.5 X 40.0MM EX-FIXATION CENTRAL BODY ANKLE 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and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 5 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-2-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1367.56, "discounted_cash": 820.54, "setting": "both", "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": 1764.6, "discounted_cash": 1058.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP POUCH DRAINABLE QUIET FILM", "code_information": [{"code": "8770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.45, "discounted_cash": 2.07, "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": 2723.95, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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": 2723.95, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 2723.95, "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": 3416.0, "discounted_cash": 2049.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW II 2 HOLE 20MM ORTHOLOC 3DSI 40240220", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40240220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1922.0, "discounted_cash": 1153.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW II 4 HOLE 20MM ORTHOLOC 3DSI 40240420", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40240420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4106.0, "discounted_cash": 2463.6, "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": 521.7, "discounted_cash": 313.02, "setting": "both", "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": 14.18, "discounted_cash": 8.51, "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": 14.15, "discounted_cash": 8.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER SHEATH LENS 4MMX 180MM", "code_information": [{"code": "LCS1800UNST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.18, "discounted_cash": 141.71, "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": 6.46, "discounted_cash": 3.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANING ADAPTERS SAFE GUIDE DISPOSABLE CLEANING ADAPTERS", "code_information": [{"code": "1214-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANING 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[{"code": "121222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.39, "discounted_cash": 2.63, "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 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5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF TEAR DUCT", "code_information": [{"code": "68530", "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": 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"CLINCH ENDOSCOPIC II 5MM 174317", "code_information": [{"code": "174317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.9, "discounted_cash": 318.54, "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": 35.64, "discounted_cash": 21.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN PHOS 900 MG VIAL 50 ML", "code_information": [{"code": "228546", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.41, "discounted_cash": 22.45, "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": 227.08, "discounted_cash": 136.25, "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 16MM HEMOSTASIS CLIP WITH 360* ROTATION. + REMOVABLE", "code_information": [{"code": "1170-02", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"standard_charges": [{"gross_charge": 30.4, "discounted_cash": 18.24, "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": 1.78, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM PILLING TANTALUM", "code_information": [{"code": "W523100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.14, "discounted_cash": 3.08, "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": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP SMALL STERILE ALLIGATOR", "code_information": [{"code": "3027715-200-2017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 491.75, "discounted_cash": 295.05, "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": 1369.88, "discounted_cash": 821.93, "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": 210.52, "discounted_cash": 126.31, "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": 638.48, "discounted_cash": 383.09, "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": 3.87, "discounted_cash": 2.32, "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": 39.23, "discounted_cash": 23.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE/EPI/KETOR/ROPIV 0.04 mg-0.25 mg-15 mg-123 mg/50 mL", "code_information": [{"code": "MED0869", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.21, "discounted_cash": 3.13, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2827.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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", 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for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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", 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1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee 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"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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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 VAGINA", "code_information": [{"code": "57120", "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": "UHC", "standard_charge_dollar": 8312.0, "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;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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 8312.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 230.65, "discounted_cash": 138.39, "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": 311.68, "discounted_cash": 187.01, "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": 464.61, "discounted_cash": 278.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE TOP STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7.01728.001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 90.0, "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 DEHISCENCE WITH PACKING 12021", "code_information": [{"code": "12021", "type": "CPT"}, {"code": "1480359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "CLOSUREFAST PROCEDURE PACK CFP", "code_information": [{"code": "CFP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.83, "discounted_cash": 179.9, "setting": "both", "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": 364.87, "discounted_cash": 218.92, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.21, "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": 4620.0, "methodology": "fee 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"standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.1, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.55, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.07, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.86, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.21, "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": 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 ACTIVITY", "code_information": [{"code": "85303", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.29, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.63, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.91, "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": "CLOTH 2% CHLORHEXIDINE GLUCONATE 9IN X 10.5IN READYPREP", "code_information": [{"code": "MSC096CHG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.82, "discounted_cash": 5.89, "setting": "both", "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": 9.03, "discounted_cash": 5.42, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.58, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2204.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "CNSLT BEFORE SCREEN COLONOSC", "code_information": [{"code": "S0285", "type": "HCPCS"}], 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"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": "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", 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.55, "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, 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7 230 2.8", "code_information": [{"code": "CS50021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COLECTOMY PARTIAL LAPAROSCOPIC W/ANASTOMOSIS/COLOPROCTOSTOMY 44207", "code_information": [{"code": "44207", "type": "CPT"}, {"code": "1480364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1245.09, "maximum": 8450.0, "gross_charge": 3773.0, "discounted_cash": 2263.8, "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": 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": 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"standard_charges": [{"minimum": 1245.09, "maximum": 8450.0, "gross_charge": 3773.0, "discounted_cash": 2263.8, "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 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": 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"standard_charges": [{"minimum": 1245.75, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 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": 1827.1, "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": 1245.75, "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 PARTIAL LAPAROSCOPIC W/REMOVAL TERMINAL ILIEUM 44205", "code_information": [{"code": "44205", "type": "CPT"}, {"code": "1480367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"maximum": 8450.0, "gross_charge": 2043.0, "discounted_cash": 1225.8, "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": 988.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, 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"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"}, 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, 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"AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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/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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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2989.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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", 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8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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. 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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"}], 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"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", 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"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 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"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": 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historical data found for payer/plan and coding combination", "standard_charge_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 OPH EXAM GENERAL ANES", "code_information": [{"code": "92018", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.45, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.36, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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 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"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 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"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 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"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": 15844.92, "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 ANKLE JET-X 40DEG EX-FIXATION CENTRAL BODY TRAUMA CLAMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71051054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7339.2, "discounted_cash": 4403.52, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 11.5MM X 5.0MM XL OFFSET FEMORAL TROCHLEA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PX02-1155-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11878.0, "discounted_cash": 7126.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 12MM 1.0MM X 1.5MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9122-1015-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 2472.0, "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": 4922.0, "discounted_cash": 2953.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 25MM HEMICAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8252-0025-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11176.0, "discounted_cash": 6705.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 52MM X 48MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8H02-5248-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11176.0, "discounted_cash": 6705.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR FEM 6-9 TIB EF 20MM SURFACE KNEE PERSONA VIVACITE-E CONTRAINED POST STAB RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5226-007-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5272.5, "discounted_cash": 3163.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR OFFSET 9.5 X 9.5MM 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8352-9595-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11624.0, "discounted_cash": 6974.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR SURFACE FEM 10-12 TIB GH 10MM left KNEE PERSONA VIVACITE-E CONTRAINED POST STAB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5126-010-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7866.0, "discounted_cash": 4719.6, "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": 1790.0, "discounted_cash": 1074.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT COUPLING PIN ROD HOFFMANN 3 INVERTED TIBIAL PLATEAU SEMI CIRCULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4922-1-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1521.5, "discounted_cash": 912.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 70MM CEMENTED CRUCIATE RETAINING LFTINTERLOK VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "183032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3200.0, "discounted_cash": 1920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 93MM KNEE OSS COBALT CHROME YOKE REINFORCED STERILE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "150493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.0, "discounted_cash": 2008.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL JOURNEY RT SZ9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL OXINIUM SZ 5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 11 HIGH OFFSET POROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71356111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9864.0, "discounted_cash": 5918.4, "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": 244.0, "discounted_cash": 146.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 CONSTRAINED LNG GAMMA NAIL LFT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "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": 4104.4, "discounted_cash": 2462.64, "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": 4104.0, "discounted_cash": 2462.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT CONSTRAINED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT MEDIAL RIGHT LAT SIGMA HIGH PERFORMANCE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102407400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "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": 8000.0, "discounted_cash": 4800.0, "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": 13540.58, "discounted_cash": 8124.35, "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": 8658.0, "discounted_cash": 5194.8, "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": 4362.0, "discounted_cash": 2617.2, "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": 8658.0, "discounted_cash": 5194.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 RIGHT PERSONA CR NARROW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5020-062-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3480.0, "discounted_cash": 2088.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMRL SZ 2 NONPOROUS RIGHT REDUCED LAT PROFILE KNEE SYS COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2154-0-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMRL SZ 4 NONPOROUS LFT REDUCED LAT PROFILE KNEE SYS COBALT CHROME IM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2153-0-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMRL SZ 4 NONPOROUS RIGHT REDUCED LAT PROFILE KNEE SYS COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2154-0-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FIXATION PHALANGEAL", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "9P15-S180-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 1015.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FXTN 12.5MM HEMICAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6125-0035-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1588.0, "discounted_cash": 952.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT GLENOID 2.5MM X 2.0MM UNIVERSAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "US202-2520-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13026.0, "discounted_cash": 7815.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT GLENOID MODULAR POST TM SAGP0002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SAGP0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "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": 2622.0, "discounted_cash": 1573.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT HUMERAL HEAD 54 X 50MM HEMICAP SHOULDER ARTHROPLASTY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8H02-5450-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10862.0, "discounted_cash": 6517.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT KNEE 20MM SZ 6-9 EF POST STABILIZED ARTICULAR SURFACE RT VITAMIN E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5224-007-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3515.0, "discounted_cash": 2109.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT KNEE 35MM PATELLA ALL POLY TOTAL KNEE IMP", "code_information": [{"code": "150-01-035", "type": "CDM"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT LUMBAR LEVEL 1 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ARTRESQL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5407.5, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT MCP SZ 10 DIST JOINT REPLACE ASCENSION IMP", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP10010DWW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3140.0, "discounted_cash": 1884.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT MCP SZ 30 DIST JOINT REPLACE ASCENSION IMP", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP10030DWW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3738.0, "discounted_cash": 2242.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT MCP SZ 30 PROXIMAL JOINT REPLACE ASCENSION IMP", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP10030PWW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5840.0, "discounted_cash": 3504.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT OVOMOTION 54 X 50MM ARTICULAR 8HM2-5450-A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8HM2-5450-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11296.0, "discounted_cash": 6777.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 32MM 3 PEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "200-02-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2314.8, "discounted_cash": 1388.88, "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": 2262.4, "discounted_cash": 1357.44, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 38MM 3 PEG CEMENTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "200-02-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2314.0, "discounted_cash": 1388.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLAR SZ 1 10MM ROUND UNCONSTRAINED KNEE SYS UHMWPE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2764-0-1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "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": 1692.0, "discounted_cash": 1015.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PRODISC C LRG DEEP 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9.820.056S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 70000.0, "discounted_cash": 42000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT RADIAL HEAD 24MM ANGLED RIGHT IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-H240R-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8482.0, "discounted_cash": 5089.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT SHOULDER CAP PRICE SGSH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BTSI-REG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "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": 2028.46, "discounted_cash": 1217.08, "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": 6030.0, "discounted_cash": 3618.0, "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": 4120.0, "discounted_cash": 2472.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TROCHLEA ART SURFACE PFXL 7.0MM X 4.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PX02-00704-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12224.0, "discounted_cash": 7334.4, "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": 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{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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"facility"}]}, {"description": "CONNECTOR SPINE ROD LEGACY TITANIUM SIDE LOADING 5.5 X 5.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "779145555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SUCTION TUBING 5 IN 1 STERILE 360", "code_information": [{"code": "360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.21, "discounted_cash": 3.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SUT SHOUDLER SUTURING DEV REQUIRES OM 8000 OPUS SMARTSTITCH PERFECT PA", "code_information": [{"code": "OM-8010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.59, "discounted_cash": 62.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR TUBING 5MM TO 70MM END OPAQUE WHT OXYGEN SUPPLY LF", "code_information": [{"code": "1420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR TUBING FLUID DISPENSE PROXIMAL DISTAL FEMALE LUER LOCK FILL UNIT DOSE LATEX FREE FDC1000 G", "code_information": [{"code": "415080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.35, "discounted_cash": 110.61, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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 THUMB REPLACEMENT", "code_information": [{"code": "26550", "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", 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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": 1170.0, "discounted_cash": 702.0, "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": 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": "CONTINUOUS INTRAOP NEUROPHYSIOLOGY MONITORING PER HOUR 95941", "code_information": [{"code": "95941", "type": "CPT"}, {"code": "40146238", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 816.91, "maximum": 8450.0, "gross_charge": 1145.0, "discounted_cash": 687.0, "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": 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": "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": "CONTOUR OF FACE BONE LESION", "code_information": [{"code": "21029", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1301.0, "methodology": "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", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": "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": 4560.0, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 NASAL HEMORRHAGE POST W/NASAL PACKS AND CAUTERY 30906", "code_information": [{"code": "30906", "type": "CPT"}, {"code": "46213821", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 363.96, "maximum": 8450.0, "gross_charge": 752.0, "discounted_cash": 451.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 363.96, "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 NASAL HEMORRHAGE; POSTERIOR WITH NASAL PACKS AND/OR CAUTERY; ANY METHOD 30905", "code_information": [{"code": "30905", "type": "CPT"}, {"code": "33040437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 67.76, "maximum": 8450.0, "gross_charge": 140.0, "discounted_cash": 84.0, "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": 67.76, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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": "CONTROLS URINE ANALYSIS", "code_information": [{"code": "975", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.28, "discounted_cash": 178.97, "setting": "both", "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": 8450.0, "methodology": "fee 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{"payer_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": 4161.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2837.34, "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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": "CONVERTER SPECIMEN 3/8 MALE PORT RETAINER PATIENT CARE FOR SUCTION CANISTER", "code_information": [{"code": "65652-122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.77, "discounted_cash": 4.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CONZ OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57461", "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": 2297.0, "methodology": "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": 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": "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": "COOLIEF MULTI PROBE KIT", "code_information": [{"code": "MCK2-17-50-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2519.0, "discounted_cash": 1511.4, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.84, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": [{"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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_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": 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 PPO", "additional_payer_notes": "No historical data found for 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORACOACROMIAL LIGAMENT RELEASE W/ OR W/O ACROMIOPLASTY 23415", "code_information": [{"code": "23415", "type": "CPT"}, {"code": "2034645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2593.75, "maximum": 9357.0, "gross_charge": 5359.0, "discounted_cash": 3215.4, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 2593.75, "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": "CORD ACTIVE FITS ENDOSTAT ENDOSTAT II BOVIE VALLEY LAB ASPEN LABS AND ERBE BRAND", "code_information": [{"code": "M00561270", "type": "CDM"}], "standard_charges": [{"gross_charge": 240.4, "discounted_cash": 144.24, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BIPLR 12FT BLUE CAUT FIT ALL STANDARD FORCEPS CABLE LF STRL", "code_information": [{"code": "DYNJ01207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.06, "discounted_cash": 5.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BIPOLAR MOLDED CONNECTOR DISP", "code_information": [{"code": "E0512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.09, "discounted_cash": 8.45, "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": 35.54, "discounted_cash": 21.32, "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": 34.53, "discounted_cash": 20.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD FREQUENCY W8 MM ELECTROSURGICAL UNITS 300CM 26006M", "code_information": [{"code": "26006M", "type": "CDM"}], "standard_charges": [{"gross_charge": 476.24, "discounted_cash": 285.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CORDINSTR LAPARASCOPY CABLE AEM DISP", "code_information": [{"code": "ES4107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.01, "discounted_cash": 31.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CORDINSTR LAPARASCOPY CABLE AEM DISP ES5107", "code_information": [{"code": "ES5107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.05, "discounted_cash": 76.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE LINK LORDOTIC LARGE 7MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LCL070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "CORE REV 14MM FREEZE DRIED BONE VOID FILLER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2035.2, "discounted_cash": 1221.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CORETRAK STERIPACK STANDARD XPCK1300", "code_information": [{"code": "XPCK1300", "type": "CDM"}], "standard_charges": [{"gross_charge": 5276.0, "discounted_cash": 3165.6, "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": 578.1, "discounted_cash": 346.86, "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": 710.0, "discounted_cash": 426.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW FT TRI PLAY 4.75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927BCF-475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 769.64, "discounted_cash": 461.78, "setting": "both", "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 PROCESSING", "code_information": [{"code": "V2785", "type": "HCPCS"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "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": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "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": "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": 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": 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 5628.0, "discounted_cash": 3376.8, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 BODY 18MM X 40-36 B250-18-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B250-18-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29990.0, "discounted_cash": 17994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORPECTOMY F3D 14.5MM X 12MM - 7 DEGREE 26MM 3CM1412-0726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3CM1412-0726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60000.0, "discounted_cash": 36000.0, "setting": "both", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "CORRECTION CLAW FINGER 26499", "code_information": [{"code": "26499", "type": "CPT"}, {"code": "1480450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "CORRECTION COCK UP 5TH TOE W/PLASTIC SKIN CLOSURE 28286", "code_information": [{"code": "28286", "type": "CPT"}, {"code": "2034644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "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": "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": 1719.0, "maximum": 8450.0, "gross_charge": 4010.0, "discounted_cash": 2406.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1940.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 LID RETRACTION 67911", "code_information": [{"code": "67911", "type": "CPT"}, {"code": "1480452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "CORTICAL FIBERS SZ LRG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "42210S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1740.0, "discounted_cash": 1044.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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{"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": 75.97, "discounted_cash": 45.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTISPORIN OTIC 1% 10ML", "code_information": [{"code": "MED0066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 114.47, "discounted_cash": 68.68, "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": 4007.5, "discounted_cash": 2404.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COTTON WEDGE BONE 5MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PCOT-181405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 1755.0, "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", 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.82, "discounted_cash": 323.29, "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": 997.2, "discounted_cash": 598.32, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK DENTAL END", "code_information": [{"code": "60-80423", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.89, "discounted_cash": 165.53, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK HEADED 3.0 CH15025", "code_information": [{"code": "CH15025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK HEADED 4.0 CH15027", "code_information": [{"code": "CH15027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK HEADLESS 2.0 CH15030", "code_information": [{"code": "CH15030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MULTISCREW ACUMED UNIV DISP", "code_information": [{"code": "80-1807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 694.07, "discounted_cash": 416.44, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 2.0/2.5 P06 N0691", "code_information": [{"code": "P06 N0691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 783.99, "discounted_cash": 470.39, "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": 1198.5, "discounted_cash": 719.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 4.5MM/6.7MM CANNULATED", "code_information": [{"code": "AR-8945CS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 620.4, "discounted_cash": 372.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 4MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 6.5 / 7.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1W130516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 196.8, "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": 1138.05, "discounted_cash": 682.83, "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": 383.5, "discounted_cash": 230.1, "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": 279.22, "discounted_cash": 167.53, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG 2MM TO 2.4MM CANNULATED", "code_information": [{"code": "AR-8737-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 491.75, "discounted_cash": 295.05, "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": 2862.0, "discounted_cash": 1717.2, "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": 2599.84, "discounted_cash": 1559.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING PIN TO ROD 3-4/5MM HII COMPACT MRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4941-1-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.72, "discounted_cash": 429.43, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING ROD TO ROD 5/5MM HII COMPACT MRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4941-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.72, "discounted_cash": 429.43, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING ROD TO TUBE HII COMPACT MRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4941-1-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 635.42, "discounted_cash": 381.25, "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": 1304.18, "discounted_cash": 782.51, "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": 390.48, "discounted_cash": 234.29, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EQUIPMENT 36IN X 36IN CLR SURG BANDED RECTANGULAR W/ RUBBERBANDINVISIHIELD", "code_information": [{"code": "DYNJE63636R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "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, 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"methodology": "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 HANDLE LIGHT FLEXIBLE GRN 2EA/ 5160-2FG", "code_information": [{"code": "5160-2FG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE SOFT OPERATING ROOM LF STRL", "code_information": [{"code": "DYNJLHS2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HEAVY DUTY VINYL RECTANGLE", "code_information": [{"code": "CFI131-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.89, "discounted_cash": 107.33, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER LIGHT HANDLE FLEXIBLE GLVLITE LF STRL DISP", "code_information": [{"code": "31140208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.8, "discounted_cash": 2.28, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PATIENT 81IN X 135IN", "code_information": [{"code": "K12T-01721", "type": "CDM"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PIN YELLOW STD SNGL USE NURSING SUPPLY THERMOPLASTIC PROTECT FROM SHARP EN", "code_information": [{"code": "101001PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.74, "discounted_cash": 5.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PROBE INTEROP W/ GEL", "code_information": [{"code": "PC1292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.05, "discounted_cash": 58.23, "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": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SIZE#3 GLIDESCOPE DISPOSABLE", "code_information": [{"code": "270-0627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.4, "discounted_cash": 39.84, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SIZE#4 GLIDESCOPE DISPOSABLE", "code_information": [{"code": "270-0629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.4, "discounted_cash": 39.84, "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": 5.06, "discounted_cash": 3.04, "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": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND XL 30IN X 57IN MAYO PP LF STRL", "code_information": [{"code": "DYNJP2510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.67, "discounted_cash": 5.8, "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": 6.61, "discounted_cash": 3.97, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 50IN X 90IN SURG REINFORCED LF STRL DISP", "code_information": [{"code": "DYNJP2316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.03, "discounted_cash": 5.42, "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": 7.2, "discounted_cash": 4.32, "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": 1347.32, "discounted_cash": 808.39, "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": 605.0, "discounted_cash": 363.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 224.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "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": "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": 19011.47, "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": "CRANIAL BUR 4.0MM ROUND DIAMOND 5820-012-040D", "code_information": [{"code": "5820-012-040D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.28, "discounted_cash": 198.77, "setting": "both", "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 SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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 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": "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": "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 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": 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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.27, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.12, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed 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"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 22MM FIXED", "code_information": [{"code": "1200-0066", "type": "CDM"}], "standard_charges": [{"gross_charge": 2552.0, "discounted_cash": 1531.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSS CONNECTOR 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "39-CC-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4170.6, "discounted_cash": 2502.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK SFTA1420", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SFTA1420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5600.0, "discounted_cash": 3360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK SMALLFX.TL.1040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX.TL.1040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5600.0, "discounted_cash": 3360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK SURG 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1883-41-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4394.64, "discounted_cash": 2636.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK SURG 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1883-41-042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4394.64, "discounted_cash": 2636.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSTIE 3.0 X 3.0 X 0 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1443-3300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3390.0, "discounted_cash": 2034.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSTIE 3.0 X 3.0MM X 10 DEG PEEK", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1443-3310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3032.0, "discounted_cash": 1819.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUSH MIX ZVPRO 10CC ZVPCM-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZVPCM-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUSH-MIX ZVPRO 10CC (DBM) ZVPCM-10.00", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ZVPCM-10.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8800.0, "discounted_cash": 5280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUSH-MIX ZVPRO 5.00CC ZVPCM-05.00", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ZVPCM-05.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "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": 49.8, "discounted_cash": 29.88, "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": 53.98, "discounted_cash": 32.39, "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": 50.23, "discounted_cash": 30.14, "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": 49.03, "discounted_cash": 29.42, "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": 93.96, "discounted_cash": 56.38, "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 PRESERVED BONE VIBONE MATRIX 1 CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "VIB-0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYO PRESERVED BONE VIBONE MATRIX 2 CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "VIB-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYO PRESERVED BONE VIBONE MATRIX 5 CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "VIB-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9750.0, "discounted_cash": 5850.0, "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": 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": 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 LESION 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schedule"}, {"payer_name": "AETNA", "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": 2723.95, "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": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "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": "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": "CRYPTOCOCCAL", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "1231824", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 234.0, "discounted_cash": 140.4, "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": 15.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 86.9, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.24, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 35.24, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 Glu", "code_information": [{"code": "82945", "type": "CPT"}, {"code": "1099836", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 39.0, "discounted_cash": 23.4, "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": 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": 14.48, "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": "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": 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", "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": 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": 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": 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 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": 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 TP", "code_information": [{"code": "84157", "type": "CPT"}, {"code": "1099835", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 295.0, "discounted_cash": 177.0, "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": 5.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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 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": 5332.0, "discounted_cash": 3199.2, "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": 2188.78, "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": 2188.78, "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": 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": 2699.59, "methodology": "fee schedule"}, {"payer_name": "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": 1980.3, "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": "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": 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 245.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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 Aspiration 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "627588", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2010.0, "discounted_cash": 1206.0, "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": 825.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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": 825.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1017.66, "methodology": "fee schedule"}, {"payer_name": "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": 746.51, "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": 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 Aspiration Renal Left 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "629780", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2010.0, "discounted_cash": 1206.0, "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": 825.1, "methodology": "fee schedule"}, {"payer_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": 825.1, "methodology": "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": 1017.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 746.51, "methodology": "fee schedule"}, {"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 Aspiration Renal Right 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "627590", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2010.0, "discounted_cash": 1206.0, "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": 825.1, "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": 825.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1017.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 746.51, "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": 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 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", "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": 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"}, {"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 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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": 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"type": "CPT"}, {"code": "629782", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2010.0, "discounted_cash": 1206.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 825.1, "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", 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"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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 Chest High Resolution 71250", "code_information": [{"code": "71250", "type": "CPT"}, {"code": "36648783", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 688.0, "discounted_cash": 412.8, "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": 282.42, "methodology": "fee schedule"}, {"payer_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": 282.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "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": 348.33, "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": 255.52, "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 Drain Retroperitoneal Absc 75989", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "629816", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 922.0, "discounted_cash": 553.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 378.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_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": 378.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 466.8, "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": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 342.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.76, "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", "standard_charge_dollar": 474.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 572.56, "methodology": "fee schedule"}, {"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": "CT Drain Subdiaphragm/Subphrenic 75989", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "629818", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 922.0, "discounted_cash": 553.2, "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": 378.48, "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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 378.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 466.8, "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", "standard_charge_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": 342.43, "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", "standard_charge_dollar": 474.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 572.56, "methodology": "fee schedule"}, {"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": "CT Drainage Abscess or Cyst 75989", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "625642", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 922.0, "discounted_cash": 553.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 378.48, "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", 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 825.1, "methodology": "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": 1017.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 746.51, "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": "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 Guidance for needle placement 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "1171883", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2010.0, "discounted_cash": 1206.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 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{"payer_name": "AETNA", "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": 746.51, "methodology": "fee schedule"}, {"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 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"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", 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 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"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": 543.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 670.34, "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 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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 Hand w/ Contrast Left 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "629940", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 662.0, "discounted_cash": 397.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 271.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 271.75, "methodology": "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": 335.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 245.86, "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 Hand w/ Contrast Right 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "629944", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 662.0, "discounted_cash": 397.2, 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"standard_charge_dollar": 1980.3, "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": 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 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": 5332.0, "discounted_cash": 3199.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2188.78, "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 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": 2188.78, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2699.59, "methodology": "fee schedule"}, {"payer_name": "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": 1980.3, "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": "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 Renal Mass Protocol 74178", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "36648769", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5332.0, "discounted_cash": 3199.2, "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": 2188.78, "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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2188.78, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2699.59, "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": 1980.3, "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": "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 Renal Stone Protocol 74176", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "36648767", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5332.0, "discounted_cash": 3199.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2188.78, "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 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": 2188.78, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2699.59, "methodology": "fee schedule"}, {"payer_name": "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": 1980.3, "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": 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 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", "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 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": 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 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": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 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"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 Tibia/Fibula w/ Contrast Right 73701", "code_information": [{"code": "73701", "type": "CPT"}, {"code": "630198", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2221.0, "discounted_cash": 1332.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", 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{"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 Tibia/Fibula w/o Contrast Bl 73700", "code_information": [{"code": "73700", "type": "CPT"}, {"code": "630201", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1324.0, "discounted_cash": 794.4, "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": 543.5, "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": 543.5, "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 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": 670.34, "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": 491.73, "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": 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": 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 Tibia/Fibula w/o Contrast Left 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"AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 271.75, "methodology": "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": 335.17, "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": 245.86, "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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 271.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 335.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 245.86, "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", "standard_charge_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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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 Unlisted Procedure 76497", "code_information": [{"code": "76497", "type": "CPT"}, {"code": "630207", "type": "CDM"}, {"code": 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"code_information": [{"code": "MDS9913HPL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.94, "discounted_cash": 4.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BP DIS 1T SM ADL HP MDS9912HP", "code_information": [{"code": "MDS9912HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.16, "discounted_cash": 9.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BP INFANT 1 TUBE", "code_information": [{"code": "MDS9910HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.19, "discounted_cash": 4.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BP TOURNIQUET 24IN DOUBLE BLADDER DUAL PORT DISPOSABLE SLEEVE PLC", "code_information": [{"code": "60708015300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.25, "discounted_cash": 98.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF LARGE ADULT BP 115-027566-00", "code_information": [{"code": "115-027566-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.93, "discounted_cash": 20.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF LMA MASK SINGLE USE SIZE 2 HUD200000020H", "code_information": [{"code": "HUD200000020H", "type": "CDM"}], "standard_charges": [{"gross_charge": 28.75, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF PRESSURE BLOOD", "code_information": [{"code": "103012159", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF SMALL ADULT BP 115-027564-00", "code_information": [{"code": "115-027564-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.63, "discounted_cash": 15.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNEQUET 18IN DUAL PORT DUAL BLADDER LUER LOCK WITHOUT SLEEVE STRL DISP", "code_information": [{"code": "60708010200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.74, "discounted_cash": 59.24, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 12 X 2IN SPSB PURPLE", "code_information": [{"code": "5921-112-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.32, "discounted_cash": 70.99, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 12IN X 5IN 2 PORT 1 BLADDER DISP", "code_information": [{"code": "60707010200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 42IN DL PORT BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60707010700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET ATS 2-PORT 1-BLADDER W/O SLEEVE 8 X 2.75IN LF STRL DISP", "code_information": [{"code": "60707010100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.01, "discounted_cash": 34.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET STER DISP DPSB W PLC 18 60707010300", "code_information": [{"code": "60707010300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.01, "discounted_cash": 34.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET STER DISP DPSB W PLC 30 60707010500", "code_information": [{"code": "60707010500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNQT STERDISP DPSB W PLC 34 60707010600", "code_information": [{"code": "60707010600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "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": 47.29, "discounted_cash": 28.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TRNQT 42IN DOUBLE PORT SNGL BLADDER PUMP LN CONNECTOR REPROCESS ATS STRL DI", "code_information": [{"code": "607070107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.32, "discounted_cash": 28.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFFFT LG SNGL BLADDER UNIVERSAL NON STRL SCD EXPRESS DISP", "code_information": [{"code": "5898", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.43, "discounted_cash": 53.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFFFT REG SNGL BLADDER UNIVERSAL NON STRL SCD EXPRESS DISP", "code_information": [{"code": "5897", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.43, "discounted_cash": 53.06, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 GRAFT F/N/HF/G", "code_information": [{"code": "15155", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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/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 BACTERIA EXCEPT BLOOD", "code_information": [{"code": "87075", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.61, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 24.63, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.2, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.74, "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": 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"plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "CURETTE EAR WHT FLEXIBLE LOOP PP ADLT DISP", "code_information": [{"code": "9555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "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": 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": "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": "CUTTER 2.5 SMALL JOINT AGGRESIVE PLUS", "code_information": [{"code": "275-628-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.35, "discounted_cash": 78.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER 2.5MMX80MM TPS SMALL JOINT FULL RADIUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "275-627-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 44.4, "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": 231.68, "discounted_cash": 139.01, "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": 1041.09, "discounted_cash": 624.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER ENDOSCOPIC HUB BITE AGGRESSIVE DESIGN FORMULA STERILE 4MM", "code_information": [{"code": "375-543-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.35, "discounted_cash": 78.81, "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": 429.82, "discounted_cash": 257.89, "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": 147.27, "discounted_cash": 88.36, "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": 343.73, "discounted_cash": 206.24, "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": 103.84, "discounted_cash": 62.3, "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": 872.26, "discounted_cash": 523.36, "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": 400.93, "discounted_cash": 240.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER PROXIMATE CUTTER RELOAD UNIT 100MM TRT10", "code_information": [{"code": "TRT10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.35, "discounted_cash": 162.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER RADIUS 2.5MM GRAY FULL SMALL JOINT FORMULA INSTRUMENT", "code_information": [{"code": "375-627-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.35, "discounted_cash": 78.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER REAMER 12MM GUIDE PIN FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.3, "discounted_cash": 786.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER RESECTOR 3.5MM AGG PLUS 0375-534-000", "code_information": [{"code": "375-534-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.35, "discounted_cash": 78.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER RING BEAVER", "code_information": [{"code": "374100", "type": "CDM"}], "standard_charges": [{"gross_charge": 127.69, "discounted_cash": 76.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER SUT KNOT PUSHER FOR MENISCAL REPAIR SYS ULTRA FAST-FIX", "code_information": [{"code": "72201537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.27, "discounted_cash": 184.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER SUT KNOT PUSHER SURGINSTR FOR NUMBER 2 FIBERWIRE STRL", "code_information": [{"code": "AR-4515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 214.8, "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": 85.2, "discounted_cash": 51.12, "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": 423.06, "discounted_cash": 253.84, "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, 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[{"code": "MED0578", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.6, "discounted_cash": 33.96, "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", 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", 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[{"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": 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"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 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.15, "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": "CYSTO IMPL 4 OR MORE", "code_information": [{"code": "C9740", "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": "CYSTO RX BALO CATH URTL STRX", "code_information": [{"code": "52284", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 W/UP STRICTURE TX", "code_information": [{"code": "52342", "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": "CYSTO W/URETER STRICTURE TX", "code_information": [{"code": "52341", "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": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "setting": "outpatient", "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 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": 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": 2411.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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/URETERO STRICTURE TX", "code_information": [{"code": "52344", "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": "CYSTO/URETERO W/LITHOTRIPSY", "code_information": [{"code": "52356", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "setting": "outpatient", "payers_information": [{"payer_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 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": 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": 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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": 6074.0, "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": "52265", "type": "CPT"}], "standard_charges": [{"minimum": 1475.0, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": "CYSTOSCOPY CHEMODENERVATION", "code_information": [{"code": "52287", "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": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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 REMOVAL OF CLOTS", "code_information": [{"code": "52001", "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": 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": "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": "CYSTOSTOMY CYSTOTOMY W/DRAINAGE 51040", "code_information": [{"code": "51040", "type": "CPT"}, {"code": "1480539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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 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"code_information": [{"code": "52351", "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": "CYSTOURETERO W/BIOPSY", "code_information": [{"code": "52354", "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": "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 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"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": "CYSTOURETERO W/LITHOTRIPSY", "code_information": [{"code": "52353", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "setting": "outpatient", "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 8450.0, "methodology": "fee schedule"}, {"payer_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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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", 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"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": 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "CYSTOURETHRO W/IMPLANT", "code_information": [{"code": "52441", "type": "CPT"}], 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"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": "CYSTOURETHROSCOPY 52000", "code_information": [{"code": "52000", "type": "CPT"}, {"code": "1480541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 18082.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 18082.0, "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": 18082.0, "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": 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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 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"standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "CYSTOURETHROSCOPY BLADDER DIVERTICULECTOMY 52305", "code_information": [{"code": "52305", "type": "CPT"}, {"code": "1480544", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"plan_name": "UHC", "standard_charge_dollar": 6074.0, "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": 1519.76, "maximum": 18082.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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 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 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 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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 88291", "code_information": [{"code": "88291", "type": "CPT"}, {"code": "45452575", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 194.0, "discounted_cash": 116.4, "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": 72.05, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.77, "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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 53.73, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.93, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.36, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.04, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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, 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", 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"plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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 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"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": "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": 295.0, "discounted_cash": 177.0, "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": 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"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": 311.0, "discounted_cash": 186.6, "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", 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"plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 115.5, "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": "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 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"methodology": "fee 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": "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 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{"payer_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": "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": 234.0, "discounted_cash": 140.4, "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", 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{"description": "DBM PUTTY 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OBS-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC CAUT1000", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CAUT1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14000.0, "discounted_cash": 8400.0, "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": 953.92, "discounted_cash": 572.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 2.5CC ALLOMIX CAUT0250", "code_information": [{"code": "CAUT0250", "type": "CDM"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "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": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 5CC ALLOSYNC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-2012-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1734.4, "discounted_cash": 1040.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY APEX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "DBM-APX-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2495.0, "discounted_cash": 1497.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE BLOCK 14X14X14MM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ALIF1808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE BLOCK 14X14X14MM DBM-SBL-14", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "DBM-SBL-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE STRIP 33 X 19 X 7", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DBMSS-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE STRIP XL 50X20X7MM", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "DBM-SS-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DCS-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP 20MM X 5MM X 50MM 710-05-5020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "710-05-5020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP 710-01-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "710-01-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP AS-DS50207", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AS-DS50207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 4200.0, "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": 7000.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP LARGE 50 X 20 X 5MM PTT-PLIF-09", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PTT-PLIF-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM+ 2.5TM DBM PLUS CHIPS 2.5CC OBS-02C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OBS-02C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBMAX PUTTY 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "900050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 ABDOMINAL WALL", "code_information": [{"code": "11005", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "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": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "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": 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": "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": 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"standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 225.0, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 331.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, 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"setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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"}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 366.3, "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 FIRST 10% OF BODY SURFACE 11000", 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"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": 2723.95, "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "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": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 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": "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 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": 2723.95, "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 WRIST W/DEBRIDEMENT 25023", "code_information": [{"code": "25023", "type": "CPT"}, {"code": "1480596", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "DECOMPRESSION FASCIOTOMY WRIST W/O DEBRIDEMENT 25020", "code_information": [{"code": "25020", "type": "CPT"}, {"code": "1480598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 LEG", "code_information": [{"code": "27894", "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": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "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": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "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": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "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": "DECOMPRESSION PLANTAR DIGITAL NERVE 64726", "code_information": [{"code": "64726", "type": "CPT"}, {"code": "10710887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1028.5, "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": "DECOMPRESSION TARSAL TUNNEL RELEASE 28035", "code_information": [{"code": "28035", "type": "CPT"}, {"code": "1480595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE FASCIOTOMY HAND 26037", "code_information": [{"code": "26037", "type": "CPT"}, {"code": "29945431", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1526.05, "maximum": 8450.0, "gross_charge": 3153.0, "discounted_cash": 1891.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1526.05, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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 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[{"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.44, "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 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"plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_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": 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": 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"standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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", 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{"description": "DELAYED INSERTION BREAST PROSTHESIS AFTER RECON 19342", "code_information": [{"code": "19342", "type": "CPT"}, {"code": "1643975", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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", 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{"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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4033.64, "maximum": 6924.75, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.44, "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": 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": 33.55, "discounted_cash": 20.13, "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": 59.36, "discounted_cash": 35.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 80MG/ML PF 1ML VIAL", "code_information": [{"code": "MED0594", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.94, "discounted_cash": 30.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSOR TONGUE 6IN WOOD LF STRL", "code_information": [{"code": "MDS202075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": 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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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"minimum": 2537.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "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": "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": 8641.64, "discounted_cash": 5184.98, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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": 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", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "DESTROY VAG LESIONS SIMPLE", "code_information": [{"code": "57061", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, 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"AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "DESTRUCT 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"standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 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8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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"plan_name": "UHC", "standard_charge_dollar": 2827.0, "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 NEURO AGENT PARAVERT FACET W/IMAGE CERV.OR THOR. 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"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 BY NEUROLYTIC AGENT/PUDENDAL NERVE 64630", "code_information": [{"code": "64630", "type": "CPT"}, {"code": "1480620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "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": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54055", "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "DESTRUCTION PREMALIGNANT LESIONS 2 THROUGH 14 EACH 17003", "code_information": [{"code": "17003", "type": "CPT"}, {"code": "28169437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 PREMALIGNANT LESIONS FIRST LESION 17000", "code_information": [{"code": "17000", "type": "CPT"}, {"code": "28169436", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.54, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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{"description": "DEVICE FIXATION ULTRABUTTON ADJUSTABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72290003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 20MM FEMORAL FXTN ACL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LEAD S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.8, "discounted_cash": 317.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 25MM FEMORAL FXTN ACL PCL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 272.4, "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": 472.0, "discounted_cash": 283.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 35MM FEMORAL FXTN ACL PCL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 272.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 40MM FEMORAL FXTN ACL PCL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 272.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 4MM X 12MM BTN ACL PCL KNEE ENDOBUTTON TI STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 310.76, "discounted_cash": 186.46, "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": 1338.51, "discounted_cash": 803.11, "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": 1395.7, "discounted_cash": 837.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 10MM TIBIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "906514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1222.0, "discounted_cash": 733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 11MM TIBL W/ PRELOADED IMPLANT TUNNELOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "906515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 15MM W/ 15 MM CONTINUOUS LOOP SUT ENDOBUTTON ULTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.8, "discounted_cash": 317.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 16MM TIBL EXTENDED SPIKE CRUCIFORM WASHERLOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "908469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 807.5, "discounted_cash": 484.5, "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": 826.9, "discounted_cash": 496.14, "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": 736.5, "discounted_cash": 441.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 9MM TIBL TUNNELOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "906513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "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": 3162.0, "discounted_cash": 1897.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN KNEE CORTICAL BLOWOUT ENDO XENDOBUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 249.6, "discounted_cash": 149.76, "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": 1015.36, "discounted_cash": 609.22, "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": 1015.36, "discounted_cash": 609.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN PCL FOUR POINT LOCKING SYS TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 833.22, "discounted_cash": 499.93, "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": 1216.0, "discounted_cash": 729.6, "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 HOLDING 1.2MM 1.6MM PLATE TAKINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "320-1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE IMPLANT NON BIOASORBABLE BONE IB KIT PEEK W/ CC FT AND JUMPSTART AR-1788PJ-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1788PJ-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1944.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE INFLATION DISPOSABLE", "code_information": [{"code": "QL6015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 85.2, "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": 1221.97, "discounted_cash": 733.18, "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": 1050.94, "discounted_cash": 630.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE PULLING 240MM PUSH PULL REDUCTION DRILL BIT", "code_information": [{"code": "324.033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1087.47, "discounted_cash": 652.48, "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": 1050.94, "discounted_cash": 630.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REATTACHMENT SM TROCHANTER FOR CABLE SYS TITANIUM ALLOY STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "498.806S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4588.5, "discounted_cash": 2753.1, "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": 3990.0, "discounted_cash": 2394.0, "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": 16.79, "discounted_cash": 10.07, "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": 195.51, "discounted_cash": 117.31, "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": 149.6, "discounted_cash": 89.76, "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": 76.73, "discounted_cash": 46.04, "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": 576.05, "discounted_cash": 345.63, "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": 159.75, "discounted_cash": 95.85, "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": 1204.65, "discounted_cash": 722.79, "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": 238.0, "discounted_cash": 142.8, "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": 96.92, "discounted_cash": 58.15, "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": 82.53, "discounted_cash": 49.52, "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": 83.18, "discounted_cash": 49.91, "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": 89.98, "discounted_cash": 53.99, "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": 64.31, "discounted_cash": 38.59, "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": 71.1, "discounted_cash": 42.66, "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": 91.51, "discounted_cash": 54.91, "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": 105.47, "discounted_cash": 63.28, "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": 118.13, "discounted_cash": 70.88, "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": 111.8, "discounted_cash": 67.08, "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": 83.13, "discounted_cash": 49.88, "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": 87.26, "discounted_cash": 52.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE XPRESS LOPROFILE 6MM COMPACT W/ LIGHT DISP", "code_information": [{"code": "LPLF-206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3249.51, "discounted_cash": 1949.71, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICEINFLATION BLLN SINUS RELIEVA", "code_information": [{"code": "BID30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.69, "discounted_cash": 179.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICES IMPLANTABLE ARH SOLUTIONS 2 HEAD 26MM RIGHT 5001-0526R-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5001-0526R-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6924.76, "discounted_cash": 4154.86, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"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": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/DECADRON 4 MG/1ML 1ML VIAL", 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 49.98, "discounted_cash": 29.99, "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": 202.0, "discounted_cash": 121.2, "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": 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"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, 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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 5MM X 20MM", "code_information": [{"code": "ULF105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3455.61, "discounted_cash": 2073.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR BALLOON SINUS XPRESS ULTRA 5MM X 8MM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "ULF-205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3018.0, "discounted_cash": 1810.8, "setting": "both", "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": 3455.61, "discounted_cash": 2073.37, "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": 3018.0, "discounted_cash": 1810.8, "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": 1264.5, "discounted_cash": 758.7, "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": "DIAMOND DISC MED 25.4MM", "code_information": [{"code": "5120-130-250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.75, "discounted_cash": 170.85, "setting": "both", "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", "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": 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, "estimated_discounted_cash": 6254.86, "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": "DIGIFUSE 2.0MM 0 DEG SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF2000-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGIFUSE STANDARD 0 DEG 2.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DF2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3990.0, "discounted_cash": 2394.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGIFUSE STANDARD 0 DEG2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF2500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3990.0, "discounted_cash": 2394.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "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": 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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53600", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53601", "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 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"standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "DILATION AND CURETTAGE; NON-OBSTETRICAL 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "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": 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": 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.28, "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": "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": 1645.0, 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historical data found for payer/plan and coding 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"}, 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"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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 SALIVARY DUCT 42650", "code_information": [{"code": "42650", "type": "CPT"}, {"code": "27724000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 4433.0, "discounted_cash": 2659.8, "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": 2145.57, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 BALLOON ENDO 6.0 FR 15.0-16.5-180MM", "code_information": [{"code": "M00558370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.28, "discounted_cash": 266.57, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BLLN 15-18MM X 180 CM X 7.5FR WIREGUIDED ESOPHAGEAL PYLORIC CRE DISP", "code_information": [{"code": "M00558700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.31, "discounted_cash": 336.19, "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": 142.0, "discounted_cash": 85.2, "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": 547.95, "discounted_cash": 328.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 39FR", "code_information": [{"code": "1214-39", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 42FR", "code_information": [{"code": "1214-42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 45FR", "code_information": [{"code": "1214-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 48FR", "code_information": [{"code": "1214-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 51FR", "code_information": [{"code": "1214-51", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SAFEGUIDE DILATOR 54FR", "code_information": [{"code": "1214-54", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.95, "discounted_cash": 395.37, "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": 2862.5, "discounted_cash": 1717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS XL INSULATED TSI", "code_information": [{"code": "ML-0440S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1907.57, "discounted_cash": 1144.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 50 MG/ML--1ML", "code_information": [{"code": "MED0312", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "DIPOSABLE PUNCH F-00-55P", "code_information": [{"code": "F-00-55P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.9, "discounted_cash": 229.14, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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, 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"plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 3001.76, "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": "DISCECTOMY ANTERIOR WITH DECOMPRESSION; CERVICAL SINGLE INTERSPACE 63075", "code_information": [{"code": "63075", "type": "CPT"}, {"code": "1480659", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "DISSECTOR BALLOON TROCAR SPACEMAKER", "code_information": [{"code": "OMSXB2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.29, "discounted_cash": 423.77, "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": 3991.61, "discounted_cash": 2394.97, "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": 615.84, "discounted_cash": 369.5, "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": 17.65, "discounted_cash": 10.59, "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": 179.69, "discounted_cash": 107.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOSCOPIC 5MM 176645", "code_information": [{"code": "176645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.48, "discounted_cash": 255.29, "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": 1259.5, "discounted_cash": 755.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR SONICISION CORDLESS ULTRASONIC 39CM 14.5MM 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"standard_charge_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 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"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": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL COMPONENT 20D PYRO CARBON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-200-20D-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3690.0, "discounted_cash": 2214.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTAL COMPONENT 20P PYRO CARDBON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-200-20P-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3690.0, "discounted_cash": 2214.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTAL COMPONENT PYRO CARBON 10D", "code_information": [{"code": "PIP-200-10D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3690.0, "discounted_cash": 2214.0, "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 ACUFEX DISP ANKLE/FOOT 014407", "code_information": [{"code": "14407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.32, "discounted_cash": 74.59, "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": 4172.0, "discounted_cash": 2503.2, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "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": 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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 5892.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.21, "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": 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"standard_charge_dollar": 3565.0, "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": 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"code_information": [{"code": "FP-HEAD9", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.76, "discounted_cash": 3.46, "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": "DOPAMINE 1.6MG/ML-D5W INTRAVENOUS SOLUTION 250 ML", "code_information": [{"code": "2B0842", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 31.57, "discounted_cash": 18.94, "setting": "both", "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 STRAND GRACILLIS", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DSG-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 2412.0, "setting": "both", "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": 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": 9357.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "DRAIN 19 FR 1/4 FULL FLUTED ROUND W/TROCAR", "code_information": [{"code": "72231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.64, "discounted_cash": 8.78, "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": 105.9, "discounted_cash": 63.54, "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 BL W/CATH INSERTION", "code_information": [{"code": "51102", "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": 2297.0, "methodology": "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2989.0, "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": 224.54, "discounted_cash": 134.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHANNEL HUBLESS 3 4-FLUTE 15FR 072229", "code_information": [{"code": "72229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.78, "discounted_cash": 37.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHANNEL HUBLESS 3 4-FLUTED 15FR 072228", "code_information": [{"code": "72228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.15, "discounted_cash": 42.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST HEIMLICH STRL", "code_information": [{"code": "373460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "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": "DRAIN CHEST PLEUREVAC ADULT-PED DRY A-6000-08LF", "code_information": [{"code": "A-6000-08LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.18, "discounted_cash": 321.71, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN FLAT 10MM FULL FLUTED CHANNEL", "code_information": [{"code": "72214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.75, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN FLAT CHANNEL 7MM FULL-FLUTE TROCAR 072212", "code_information": [{"code": "72212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.26, "discounted_cash": 36.16, "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": 66.73, "discounted_cash": 40.04, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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 1/4X 12 ST", "code_information": [{"code": "DC91201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 12 X 1 2 30414-050", "code_information": [{"code": "30414-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 12X1 4 1 EACH", "code_information": [{"code": "30414-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "discounted_cash": 2.76, "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": 22.88, "discounted_cash": 13.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RND HUBLESS 10FR FLUTED TROCAR 072227", "code_information": [{"code": "72227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.78, "discounted_cash": 37.07, "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": 58.45, "discounted_cash": 35.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 10FR 072187", "code_information": [{"code": "72187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.26, "discounted_cash": 36.16, "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": 61.78, "discounted_cash": 37.07, "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 SILCN BLAKE 10FR ROUND 1 8 TRC LF 2227", "code_information": [{"code": "2227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.95, "discounted_cash": 119.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICONE 10FR", "code_information": [{"code": "70310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.42, "discounted_cash": 24.25, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN WND 7FR 3/32IN X 50IN RND END PERFORATION SI WITHOUT TROCAR JACKSON PRATT", "code_information": [{"code": "SU130-1320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.5, "discounted_cash": 20.7, "setting": "both", "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": 244.2, "discounted_cash": 146.52, "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": 213.31, "discounted_cash": 127.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND POST OP", "code_information": [{"code": "SMI-OFWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.6, "discounted_cash": 558.36, "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": 168.08, "discounted_cash": 100.85, "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": 168.08, "discounted_cash": 100.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2827.0, "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": 642.0, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2827.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 ABSCESS CYST/HEMATOMA VESTIBULE OF THE MOUTH COMPLICATED 40801", "code_information": [{"code": "40801", "type": "CPT"}, {"code": "2401819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2204.0, "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "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 EYELID ABSCESS", "code_information": [{"code": "67700", "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "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 HYDROCELE", "code_information": [{"code": "55000", "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": 2827.0, "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 NOSE LESION", "code_information": [{"code": "30020", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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(S)", "code_information": [{"code": "58805", "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": 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": 1958.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 PERITONEAL ABSCESS OR LOCALIZED PERITONITIS OF APPENDICEAL ABSCESS; OPEN 49020", "code_information": [{"code": "49020", "type": "CPT"}, {"code": "4240121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1036.2, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 1036.2, "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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 PROSTATE ABSCESS", "code_information": [{"code": "55725", "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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", 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"standard_charge_dollar": 639.84, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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, 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11.33, "discounted_cash": 6.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE 54 X 150'' LEICA/WILD MICROSCOPE ASP54-150", "code_information": [{"code": "ASP54-150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.75, "discounted_cash": 463.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ARTHROSCOPY W FLUID CONTROL POUCH 9414", "code_information": [{"code": "9414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.85, "discounted_cash": 35.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BACK TABLE STERILE-Z XL 5575", "code_information": [{"code": "5575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.79, "discounted_cash": 31.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BEACH CHAIR SHOULDER STERILE DYNJP8412", "code_information": [{"code": 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"plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "DRESS/DEBRID P-THICK BURN M", "code_information": [{"code": "16025", "type": "CPT"}], "standard_charges": [{"minimum": 402.0, "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": 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": "DRESSING 3M TEGADERM HP TRANSPARENT FILM4 X 4-1/2 MMM9546HPH", "code_information": [{"code": "MMM9546HPH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.68, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING 4 X 4 SINGLE CONTACT LAYER JUMPSTART", "code_information": [{"code": "ABS-4004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.21, "discounted_cash": 57.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING 4 X 4.75 TRANSPARENT ADHESIVE FILM TD-26C", "code_information": [{"code": "TD-26C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.83, "discounted_cash": 55.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AD ADVANTAGE SURGICAL ANTIMICROBIAL WITH SILVER 3.5 X 12IN 422606", "code_information": [{"code": "422606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.9, "discounted_cash": 62.94, "setting": "both", "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": 6.67, "discounted_cash": 4.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING ADVANCED ANTIMICROBIAL WITH SILVER 3.5X14INCH (9X35CM) 422607", "code_information": [{"code": "422607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.97, "discounted_cash": 63.58, "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": 126.91, "discounted_cash": 76.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH 0.75 INCH DISK CHG 1.5MM CENTER", "code_information": [{"code": "ET4151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.11, "discounted_cash": 20.47, "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": 33.01, "discounted_cash": 19.81, "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": 36.97, "discounted_cash": 22.18, "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": 35.82, "discounted_cash": 21.49, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5IN X 12IN SILVER SURG POST OP AQUACEL LF", "code_information": [{"code": "420670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.9, "discounted_cash": 62.94, "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": 3.0, "discounted_cash": 1.8, "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": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM PETRO 1X8", "code_information": [{"code": ".", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.33, "discounted_cash": 5.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GERMICIDAL AQUACEL HYDROFIBER/GEL SILVER 3.5X10IN STR 422605", "code_information": [{"code": "422605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.14, "discounted_cash": 57.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GERMICIDAL AQUACEL HYDROFIBER/GEL SILVER STR 422604", "code_information": [{"code": "422604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.35, "discounted_cash": 45.81, "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": 251.25, "discounted_cash": 150.75, "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": 337.33, "discounted_cash": 202.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING JUMPSTART SINGLE LAYER 1.5 X 8IN", "code_information": [{"code": "R1508-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.63, "discounted_cash": 58.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MYRIAD MATRIX 5 X 5CM SR03LG0505US", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "SR03LG0505US", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 440.94, "discounted_cash": 264.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL 4 CM FRIM BIORESORBABLE NASOPORE", "code_information": [{"code": "5400-020-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.4, "discounted_cash": 295.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL 4 CM X 4 CM SINUS OTOLOGIC PACKING MEROGEL", "code_information": [{"code": "1517000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 282.2, "discounted_cash": 169.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL HEMOSTATIC HEMOPORE 8CM", "code_information": [{"code": "5400-020-208", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 927.3, "discounted_cash": 556.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL MEROCEL STAND W/O STRING 8CM X 1.5CM X 2CM X 20", "code_information": [{"code": "400402 (Dressing)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 559.41, "discounted_cash": 335.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL SINUS STENT BIORESORBABLE MEROPACK", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "1520001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.18, "discounted_cash": 190.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NON ADHERANT 3IN X 3IN ADAPTIC STRL", "code_information": [{"code": "ET 2012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PRIMAPORE 11.75\"X4\" 66000321", "code_information": [{"code": "66000321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PRIMAPORE 4X3.125 66000317", "code_information": [{"code": "66000317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PRIMAPORE 6X3.125 66000318", "code_information": [{"code": "66000318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PRIMAPORE 8X4 66000319", "code_information": [{"code": "66000319", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PROTECTIVE DISK 1IN 4MM W/ CHG BIOPATCH", "code_information": [{"code": "4150 DUP.", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.93, "discounted_cash": 25.16, "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": 33.87, "discounted_cash": 20.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING 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"discounted_cash": 186.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP 2.3MM/4.0MM 10MM", "code_information": [{"code": "1100-9510", "type": "CDM"}], "standard_charges": [{"gross_charge": 606.96, "discounted_cash": 364.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP 2.3MM/4.0MM 12MM", "code_information": [{"code": "1100-9012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.32, "discounted_cash": 358.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP 2.3MM/4.0MM 12MM- SHORT", "code_information": [{"code": "1100-9024", "type": "CDM"}], "standard_charges": [{"gross_charge": 606.96, "discounted_cash": 364.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP 2.3MM/4.0MM 14MM", "code_information": [{"code": "1100-9019", "type": "CDM"}], "standard_charges": [{"gross_charge": 606.96, "discounted_cash": 364.18, "setting": 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267.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.0 MM CANNULATED HEX", "code_information": [{"code": "HT-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.48, "discounted_cash": 323.09, "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": 465.65, "discounted_cash": 279.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.0MM FUSION SCREW STEM", "code_information": [{"code": "316-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 716.55, "discounted_cash": 429.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.0MM REDUCT DRVR-HCS-0110", "code_information": [{"code": "DRVR-HCS-0110", "type": "CDM"}, {"code": "272", "type": 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"RC"}], "standard_charges": [{"gross_charge": 231.15, "discounted_cash": 138.69, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEX 3.5MMINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "623.21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEX TIP MHP022", "code_information": [{"code": "MHP022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2012.91, "discounted_cash": 1207.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEXALOBE T15 STICK FIT", "code_information": [{"code": "80-0760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 796.64, "discounted_cash": 477.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEXALOBE T8 STICK FIT", "code_information": [{"code": "80-0759", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.44, "discounted_cash": 193.46, "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": 137.78, "discounted_cash": 82.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 2.5MMINSTR", "code_information": [{"code": "HCP-0025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.5, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 2MM 2.4MM CANNULATED MANUAL HPSINSTR", "code_information": [{"code": "316-0102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 606.3, "discounted_cash": 363.78, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW TAPERED HEXSTAR MAXLOCK EXTREME", "code_information": [{"code": "MXS-056T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1379.46, "discounted_cash": 827.68, "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": 494.67, "discounted_cash": 296.8, "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": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER STEM EXACT T8 XSD02003", "code_information": [{"code": "XSD02003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T15 6IN LONG STICK FIT HEXALOBE 80-1065", "code_information": [{"code": "80-1065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 796.64, "discounted_cash": 477.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T6 CANNULATED HEXALOBE 80-4149", "code_information": [{"code": "80-4149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 736.22, "discounted_cash": 441.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T8 CANNULATED HEXALOBE 80-4151", "code_information": [{"code": "80-4151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.19, "discounted_cash": 504.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T8 MPN30006", "code_information": [{"code": "MPN30006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.65, "discounted_cash": 446.79, "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": 517.04, "discounted_cash": 310.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER TIP STICK FIT T6", "code_information": [{"code": "80-1756", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 752.38, "discounted_cash": 451.43, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER TWIST OFF 2.5MM CD-TW-3025", "code_information": [{"code": "CD-TW-3025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 798.04, "discounted_cash": 478.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER UNIVERSAL EX FIX SIDEKICK", "code_information": [{"code": "RRM5005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.09, "discounted_cash": 318.65, "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": 443.98, "discounted_cash": 266.39, "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": 458.95, "discounted_cash": 275.37, "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": 26.56, "discounted_cash": 15.94, "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": 9.18, "discounted_cash": 5.51, "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": 1.8, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.21, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.54, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 DRAPE KIT SPY-PHI", "code_information": [{"code": "HH9006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.85, "discounted_cash": 203.31, "setting": "both", "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": 1100.0, "discounted_cash": 660.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.09, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.89, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 0.51, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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/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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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/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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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/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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "DRY FLEX AMNION BARRIER 4X8 CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}, {"code": "PM-020408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10560.0, "discounted_cash": 6336.0, "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": 921.4, "discounted_cash": 552.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DSPNG PIN MULTI ACCESS MINISPIKE MM412012", "code_information": [{"code": "MM412012", "type": "CDM"}], "standard_charges": [{"gross_charge": 120.04, "discounted_cash": 72.02, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2204.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 >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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": "DUAL OCTRODE SYSTEM DOS", "code_information": [{"code": "C1816", "type": "HCPCS"}, {"code": "DOS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54720.0, "discounted_cash": 32832.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "DURA REPAIR, REGN. MATRIX", "code_information": [{"code": "Q4105", "type": "HCPCS"}, {"code": "62106", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 430.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DURAL REPAIR DURASTAT GZL-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GZL-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1780.0, "discounted_cash": 1068.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DURASEAL", "code_information": [{"code": "MED0075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DURASEAL DURAL 5ML SEALANT SYSTEM", "code_information": [{"code": "20-2050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2713.38, "discounted_cash": 1628.03, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 837.66, "discounted_cash": 502.6, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "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": 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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 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": 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", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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": 4620.0, "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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": "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": 2110.0, "discounted_cash": 1266.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNACLIP 10 X 10 X 10MM 3000-01-101010", "code_information": [{"code": "3000-01-101010", "type": "CDM"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNACLIP 14 X 14 X 14MM 3000-01-141414", "code_information": [{"code": "3000-01-141414", "type": "CDM"}], "standard_charges": [{"gross_charge": 3200.0, "discounted_cash": 1920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNACLIP BONE FIXATION SYSTEM 18MM X 20MM X 20MM 3000-00-182020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-182020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4940.0, "discounted_cash": 2964.0, "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": 5336.0, "discounted_cash": 3201.6, "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": "DYNASTY A-CLASS 15 DG POLY LINER 36MM GROUP E DLXPLE36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DLXPLE36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNASTY A-CLASS 36MM 15DG GROUP D CROSSLINKED POLY LINER DLXPLD36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DLXPLD36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNASTY A-CLASS 36MM STD GROUP D CROSSLINKED POLY LINER DLXPGD36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DLXPGD36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNASTY BIOFOAM SHELL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DBFPGE54", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4483.17, "maximum": 7696.49, "estimated_discounted_cash": 5864.65, "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": 88.8, "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 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": 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 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 15 71341015", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71341015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3560.0, "discounted_cash": 2136.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECH PRI FEM COMP SO SZ 17 71341017", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71341017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3560.0, "discounted_cash": 2136.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHELON 60 RELOAD BLACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60GTINACTIVE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.7, "discounted_cash": 146.22, "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": 130.0, "discounted_cash": 78.0, "setting": "both", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "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": 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": 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": 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": 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": 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", "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 30.57, "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": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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"}, {"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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 851.71, "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": 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": 1301.0, "methodology": "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", "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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "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": 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", "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 WHOLE HEALTH", "standard_charge_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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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": 435.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 4620.0, "methodology": "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": 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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "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": 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": 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": 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data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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, 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"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": "ECODRI-SAFE ABSORBENT ROLL USA-ECO100", "code_information": [{"code": "USA-ECO100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.2, "discounted_cash": 370.92, "setting": "both", "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", 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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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "ED APPLICATION OF FINGER SPLINT; DYNAMIC", "code_information": [{"code": "29131", "type": "CPT"}, {"code": "1650463", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 565.0, "discounted_cash": 339.0, "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": 273.46, "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": "ED APPLICATION OF LONG LEG CAST (THIGH TO TOES);", "code_information": [{"code": "29345", "type": "CPT"}, {"code": "1650466", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1132.0, "discounted_cash": 679.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": 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547.88, "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 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": 225.0, "maximum": 8450.0, "gross_charge": 565.0, "discounted_cash": 339.0, "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": 273.46, "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": "ED APPLICATION SHORT ARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}, {"code": "1650385", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1132.0, "discounted_cash": 679.2, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 547.88, "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", 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"standard_charge_dollar": 547.88, "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": 225.0, "maximum": 8450.0, "gross_charge": 565.0, "discounted_cash": 339.0, "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, 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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 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "EEG during nonintracranial surgery 95955", "code_information": [{"code": "95955", "type": "CPT"}, {"code": "40031505", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 699.29, "maximum": 8450.0, "gross_charge": 995.0, "discounted_cash": 597.0, "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": 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; recording in coma or sleep only 95822", "code_information": [{"code": "95822", "type": "CPT"}, {"code": "33304649", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1468.53, "maximum": 8450.0, "gross_charge": 995.0, "discounted_cash": 597.0, "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": 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; recording recording awake and asleep 95819", "code_information": [{"code": "95819", "type": "CPT"}, {"code": "45338813", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1657.67, "maximum": 8450.0, "gross_charge": 1034.0, "discounted_cash": 620.4, "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": 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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 302.77, "discounted_cash": 181.66, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.8, "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": 8450.0, "methodology": "fee 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": 58.57, "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": "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. SIMPLE OR COMP. BRAIN/SPINE W/O PROG. 95970", "code_information": [{"code": "95970", "type": "CPT"}, {"code": "1700065", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "gross_charge": 3655.0, "discounted_cash": 2193.0, "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": 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": "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": 3655.0, "discounted_cash": 2193.0, "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": "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": 1769.02, "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": "ELEC. ANALYSIS OF PROGRAM IMPLANT. PUMP FOR INTRATHECAL/EPIDURAL W/REPROGRAM 62368", "code_information": [{"code": "62368", "type": "CPT"}, {"code": "2401961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 92.82, "maximum": 8450.0, "gross_charge": 3655.0, "discounted_cash": 2193.0, "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": "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", "standard_charge_dollar": 1769.02, "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": "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", "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": 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"}]}, 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"standard_charges": [{"gross_charge": 86.27, "discounted_cash": 51.76, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG STRESS FOAM 3PK", "code_information": [{"code": "MDSM611903CT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG TAB 10/CARD", "code_information": [{"code": "MDSM616101Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG TAB 10CARD 5000CS ADU MDS616201AG", "code_information": [{"code": "MDS616201AG", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG UNIVERSAL EKG MONITORING STRESS HOLTER DIAPHORETIC SNAP FOAM MEDI", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "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": 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[{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPTY PCA VIAL WITH INJECTOR", "code_information": [{"code": "60210421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.84, "discounted_cash": 613.7, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPWR 3D FEMUR-POROUS COATED RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "243-02-106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4100.0, "discounted_cash": 2460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPWR TIBIA POROUS COATED RIGHT 353-04-106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "353-04-106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 1500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EMULSION FAT 100 ML 20 PCT IVINTRALIPID", "code_information": [{"code": "2B6030", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 51.58, "discounted_cash": 30.95, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "END CAP OLECRANON OSTEOTOMY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.007.002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 468.18, "discounted_cash": 280.91, "setting": "both", "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": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDCAP X-CORE 2 TI 0DEG 22MM X 22MM X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7226000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5050.0, "discounted_cash": 3030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDCAP X-CORE 2 TI 12DEG 22MM X 22MM X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7226012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5050.0, "discounted_cash": 3030.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 520.6, "discounted_cash": 312.36, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "ENDOBUTTON 10MM CL ULTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 694.4, "discounted_cash": 416.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "ENDOCERVICAL CURETTAGE", "code_information": [{"code": "57505", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 3802.77, "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": "ENDOKNOT 0 VICRYL COATED 42 JK10G", "code_information": [{"code": "JK10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.9, "discounted_cash": 53.94, "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": 106.32, "discounted_cash": 63.79, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"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": "ENDONEEDLE SIZE 0 110CM 24MM TAPERCUT EC11", "code_information": [{"code": "EC11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.74, "discounted_cash": 131.24, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH W/BIOPSY; INCL. 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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. 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": 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"fee schedule"}, {"payer_name": "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": 1827.1, "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": "ENDOSKELETON TO IMPLANT 4 DEGREE PLIF 22 X 9 10 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3114-2210-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "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": 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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 ABLATION THERAPY OF INCOMPETENT VEIN; EXTREMITY; FIRST VEIN TREATED 36475", "code_information": [{"code": "36475", "type": "CPT"}, {"code": "45542922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5627.0, "discounted_cash": 3376.2, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.46, "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS ABLATION THERAPY/VEIN; TREATED IN A SINGLE EXTREMITY 36476", "code_information": [{"code": "36476", "type": "CPT"}, {"code": "45557783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 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": 639.84, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "ENDPLATE INFERIOR L 8* PRODISC PDL-L-IP08S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-IP08S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13760.0, "discounted_cash": 8256.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDPLATE SUPERIOR L 3* PRODISC PDL-L-SP03S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-SP03S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13760.0, "discounted_cash": 8256.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENLARGED ORTHO SPLIT SHEET, TIBURON", "code_information": [{"code": "29440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.59, "discounted_cash": 17.75, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3249.51, "discounted_cash": 1949.71, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.1, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 4172.0, "discounted_cash": 2503.2, "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", 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{"description": "EPIDIDYMOVASOSTOMY BILATERAL 54901", "code_information": [{"code": "54901", "type": "CPT"}, {"code": "1480715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 65.41, "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": "EPIMED COUDE INSERTION NEEDLE", "code_information": [{"code": "EPMD1060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 59.28, "discounted_cash": 35.57, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 30MG/30 ML", "code_information": [{"code": "MED0078", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 527.9, "discounted_cash": 316.74, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE-LIDOCAINE 1:200,000-1% SOL 30 ML", "code_information": [{"code": "MED0792", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.29, "discounted_cash": 16.97, "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": 32.83, "discounted_cash": 19.7, "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": 5628.0, "discounted_cash": 3376.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 5628.0, "discounted_cash": 3376.8, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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, "estimated_discounted_cash": 1374.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "ERYTHROMYCIN OPHTHALMIC 0.5% OINTMENT 3.5 GM", "code_information": [{"code": "MED0077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 51.07, "discounted_cash": 30.64, "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": 29.04, "discounted_cash": 17.42, "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": "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 ENDOSCOPY DILATION", "code_information": [{"code": "43226", "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": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 FUNCTION TEST; RECORDING/ ANALYSIS 91037", "code_information": [{"code": "91037", "type": "CPT"}, {"code": "44756889", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 510.19, "maximum": 8450.0, "gross_charge": 995.0, "discounted_cash": 597.0, "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": 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": "ESOPHAGEAL MOTILITY STUDY 91010", "code_information": [{"code": "91010", "type": "CPT"}, {"code": "31808789", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": 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HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 CONTROL BLEED", "code_information": [{"code": "43227", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 TRANSORAL W/ABLATION OF TUMOR/POLYP/LESION 43229", "code_information": [{"code": "43229", "type": "CPT"}, {"code": "18354026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2989.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2989.0, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "ESOPHAGOSCOPY RIGID TRNSO DX", "code_information": [{"code": "43191", "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": "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2989.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 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 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": 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": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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/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": 234.0, "discounted_cash": 140.4, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.16, "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": 86.9, "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 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"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": 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"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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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{"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 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"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": 43.05, "discounted_cash": 25.83, "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": 22.91, "discounted_cash": 13.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SMOKE PENCIL", "code_information": [{"code": "CVPLP2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.76, "discounted_cash": 52.66, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SMOKE SURGICAL OPERATING ROOM PLUME AWAY 4.0", "code_information": [{"code": "620030604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.58, "discounted_cash": 43.55, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 250.18, "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 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", "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.26, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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-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": 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": "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": 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 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": 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": "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": 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": "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": 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.37, "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 OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "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": 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": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "EXAM UNDER ANESTHESIA ANORECTAL 45990", "code_information": [{"code": "45990", "type": "CPT"}, {"code": "1480730", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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 S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "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": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD", "code_information": [{"code": "15830", "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": "EXC SKIN ABD ADD-ON", "code_information": [{"code": "15847", "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": 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": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [{"code": "11602", "type": "CPT"}], "standard_charges": [{"minimum": 762.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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OR CURRETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS/ULNA EXC. 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", 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WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"272", "type": "RC"}], "standard_charges": [{"gross_charge": 565.93, "discounted_cash": 339.56, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 ARM", "code_information": [{"code": "15836", "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": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "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": "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 INTRASPINL LESION CRV", "code_information": [{"code": "63265", "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": 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": "EXCISE INTRSPINL LESION CRVL", "code_information": [{"code": "63270", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63268", "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": 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": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63273", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "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": 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": "EXCISE LESION TESTIS", "code_information": [{"code": "54512", "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": "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 B9 TUMOR", "code_information": [{"code": "21030", "type": "CPT"}], "standard_charges": [{"minimum": 1508.0, "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": 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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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 SUBLINGUAL GLAND", "code_information": [{"code": "42450", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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"}], 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR 69110", "code_information": [{"code": "69110", "type": "CPT"}, {"code": "1718540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "setting": "both", 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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 FULL THICKNESS TUMOR BY PROCTOTOMY 45172", "code_information": [{"code": "45172", "type": "CPT"}, {"code": "1480767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_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": 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": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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", 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coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "EXCISION INFERIOR TURBINATE/PARTIAL OR COMPLETE 30130", "code_information": [{"code": "30130", "type": "CPT"}, {"code": "1480771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "EXCISION LESION INTRANASAL-EXTERNAL APPROACH 30118", "code_information": [{"code": "30118", "type": "CPT"}, {"code": "1480774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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", 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3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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"code_information": [{"code": "11765", "type": "CPT"}, {"code": "1480813", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 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"gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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 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"standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 FACIAL BONES 21026", "code_information": [{"code": "21026", "type": "CPT"}, {"code": "2025480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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 BONE MANDIBLE 21025", "code_information": [{"code": "21025", "type": "CPT"}, {"code": "2156871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9483.98, "gross_charge": 19595.0, "discounted_cash": 11757.0, "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 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8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 2019.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 50.36, "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 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": 5628.0, "discounted_cash": 3376.8, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"methodology": "fee schedule"}, {"payer_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 CYSTIC HYGROMA AXILLARY OR CERVICAL W/DEEP NEUROVASCULAR DISSECTION 38555", "code_information": [{"code": "38555", "type": "CPT"}, {"code": "42695185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1461.19, "maximum": 8450.0, "gross_charge": 3019.0, "discounted_cash": 1811.4, "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": 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": 1461.19, "methodology": "fee schedule"}, {"payer_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 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 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 FRENUM LABIAL OR BUCCAL 40819", "code_information": [{"code": "40819", "type": "CPT"}, {"code": "9761824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "41827", "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": 2297.0, "methodology": "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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"}], 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"HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "setting": 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"CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 5628.0, "discounted_cash": 3376.8, "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, 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historical data found for payer/plan and coding 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 MOUTH LESION", "code_information": [{"code": "41116", "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 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 3140.0, "discounted_cash": 1884.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA CUTANEOUS NERVE 64788", "code_information": [{"code": "64788", "type": "CPT"}, {"code": "7209643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1566.7, "maximum": 8450.0, "gross_charge": 3237.0, "discounted_cash": 1942.2, "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": 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3140.0, "discounted_cash": 1884.0, "setting": 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1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "EXCISION OF SKIN/TISSUE HIDRADENITIS COMPLEX 11463", "code_information": [{"code": "11463", "type": "CPT"}, {"code": "1480862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "EXCISION OF SKIN/TISSUE HIDRADENITIS 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"standard_charge_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": 1519.76, "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": "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 SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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", 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"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": 2723.95, "methodology": "fee schedule"}, {"payer_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 42860", "code_information": [{"code": "42860", "type": "CPT"}, {"code": "18076075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1623.82, "maximum": 8450.0, "gross_charge": 3355.0, "discounted_cash": 2013.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, 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"standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1827.1, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "EXCISION OF VAGINAL SEPTUM 57130", "code_information": [{"code": "57130", "type": "CPT"}, {"code": "1480869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "EXCISION OF VARIOCELE 55530", "code_information": [{"code": "55530", "type": "CPT"}, {"code": "1480870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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"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"}], 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{"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 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"standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 816.0, "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": 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"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": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4172.0, "discounted_cash": 2503.2, "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", 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{"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 820.72, "discounted_cash": 492.43, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "fee schedule"}, {"payer_name": "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 FOR UNDESCENDED TESTIS 54550", "code_information": [{"code": "54550", "type": "CPT"}, {"code": "1480917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 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": 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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2676.52, "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": 1824.9, "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 WOUND ABDOMEN 20102", "code_information": [{"code": "20102", "type": "CPT"}, {"code": "1480924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 639.36, "maximum": 8450.0, "gross_charge": 1321.0, "discounted_cash": 792.6, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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 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"HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 EPIDIDYMIS", "code_information": [{"code": "54865", "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": "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": 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": 8312.0, "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": 4620.0, "methodology": "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": "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": 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": "EXPLORE WOUND NECK", "code_information": [{"code": "20100", "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": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "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": "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": "67414", "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": 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": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 487.8, "discounted_cash": 292.68, "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": 257.48, "discounted_cash": 154.49, "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": 2120.0, "discounted_cash": 1272.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION SET 60IN WITH M/F LUER LOCK MINI VOLUME", "code_information": [{"code": "536020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.43, "discounted_cash": 2.66, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION SET DUAL PORT Q2", "code_information": [{"code": "95906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.35, "discounted_cash": 9.21, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "55810", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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": 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": "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": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "EXTENSIVE THYROID SURGERY", "code_information": [{"code": "60254", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "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": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENTION PLATE ACU-LOK 2 VDR NEUTRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.2, "discounted_cash": 738.72, "setting": "both", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 FLANGE NUT 10MM SALVATION", "code_information": [{"code": "SEF33001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.55, "discounted_cash": 227.13, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTERNAL FRAME 180MM SALVATION", "code_information": [{"code": "SEFA2180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17921.54, "discounted_cash": 10752.92, "setting": "both", "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 SHORT WIRE POST SALVATION", "code_information": [{"code": "SEF00025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.91, "discounted_cash": 524.35, "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": "EXTRA INTRODUCER", "code_information": [{"code": "CRI-17-50-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.45, "discounted_cash": 174.87, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRA PROBE", "code_information": [{"code": "CRP-17-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.93, "discounted_cash": 477.56, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRA PROBE CRP-17-75", "code_information": [{"code": "CRP-17-75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.93, "discounted_cash": 477.56, "setting": "both", "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "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": 1519.76, "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 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 OF LENS", "code_information": [{"code": "66930", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "EXTRACTION OF LENS", "code_information": [{"code": "66940", "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": 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": "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": 181.5, "discounted_cash": 108.9, "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": 182.88, "discounted_cash": 109.73, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR BROKEN SCREW 6MM 6\" LONG SINGLE USE SXT007", "code_information": [{"code": "SXT007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 955.4, "discounted_cash": 573.24, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR BROKEN SCREW 7MM 6\" LONG SINGLE USE SXT008", "code_information": [{"code": "SXT008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 955.4, "discounted_cash": 573.24, "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": 870.14, "discounted_cash": 522.08, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 1.5MM EASYOUTINSTR", "code_information": [{"code": "80-0598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.99, "discounted_cash": 301.79, "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": 11.45, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 2.2FR 115 CM URETERAL NITINOL NGAGE", "code_information": [{"code": "G48296", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 681.85, "discounted_cash": 409.11, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STRIPPED SCREW 3MM 6\" LONG SINGLE USE SXT010", "code_information": [{"code": "SXT010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1025.65, "discounted_cash": 615.39, "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": "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 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 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.11, "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": 167.87, "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": "Ethanol Level", "code_information": [{"code": "80320", "type": "CPT"}, {"code": "633725", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 396.0, "discounted_cash": 237.6, "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 WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 147.07, "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": "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 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"code_information": [{"code": "93225", "type": "CPT"}, {"code": "44798073", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "gross_charge": 899.0, "discounted_cash": 539.4, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": "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": "FACE SHIELD STERISHIELD 8 TOGA ZIPPERED 2XL 0424-841-100", "code_information": [{"code": "424-841-100", "type": "CDM"}], "standard_charges": [{"gross_charge": 160.88, "discounted_cash": 96.53, "setting": "both", "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": 5.74, "discounted_cash": 3.44, "setting": "both", "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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"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", "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": "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 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.38, "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 GRAFT BY STRIPPER 20920", "code_information": [{"code": "20920", "type": "CPT"}, {"code": "42593890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": 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{"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 COMP SZ 6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"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": 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 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{"payer_name": "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": 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": 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", 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"RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR NONPOROUS SZ 10 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "241-01-110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR NONPOROUS SZ 5 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "241-01-105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR PS NONPORUS SIZE 8 LEFT 241-01-108", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "241-01-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR STEM PRO PLASMA Z CLASSIC SZ 5 EXTENDED SHORT NECK PHAPCLE5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PHAPCLE5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR, NONPOROUS SIZE 9 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "241-01-109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL 250MCG/5ML AMP", "code_information": [{"code": "MED0461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.79, "discounted_cash": 4.07, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4474.0, "discounted_cash": 2684.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER CORTICAL LG DENIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "422105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1740.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER THERAPY LASER AURA XP", "code_information": [{"code": "10-0612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1430.0, "discounted_cash": 858.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERGRAFT BG PUTTY GPS M 6CC 76000060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76000060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2570.0, "discounted_cash": 1542.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH 1.5MM STRAIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "AR-4580S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.4, "discounted_cash": 715.44, "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": 1073.16, "discounted_cash": 643.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH IMPLANT REVERSE CURVE AR-4570R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4570R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1073.16, "discounted_cash": 643.9, "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": 1192.4, "discounted_cash": 715.44, "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": 878.04, "discounted_cash": 526.82, "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": 685.36, "discounted_cash": 411.22, "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": 1073.16, "discounted_cash": 643.9, "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": 840.0, "discounted_cash": 504.0, "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": 746.28, "discounted_cash": 447.77, "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": 533.06, "discounted_cash": 319.84, "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": 1138.2, "discounted_cash": 682.92, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DR LBRLTAPE WHITE & TT BL/BLK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "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": 689.42, "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": 593.98, "discounted_cash": 356.39, "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": 5625.96, "discounted_cash": 3375.58, "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": 547.95, "discounted_cash": 328.77, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE CERCLAGE W/O NEEDLE AR-7268", "code_information": [{"code": "AR-7268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.12, "discounted_cash": 707.47, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBREOPTIC LIGHT ILLUMINROE 6460-022", "code_information": [{"code": "6460-022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.79, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "FIBRIN SEALANT 10ML VISTASEAL VST10", "code_information": [{"code": "VST10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.37, "discounted_cash": 744.82, "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": 422.17, "discounted_cash": 253.3, "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": 422.17, "discounted_cash": 253.3, "setting": "both", "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.08, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.65, "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "FIBULAR PLATE CLUSTER 9 HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-203-L009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3243.5, "discounted_cash": 1946.1, "setting": "both", "billing_class": "facility"}]}, {"description": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 SYSTEM 4.3MM X 14.5MM HAMMERTECH SMALL PIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HT-10-1130-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3970.0, "discounted_cash": 2382.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION 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"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 ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "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", 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"discounted_cash": 3.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "FLUOROMETHOLONE 0.1% OPHTH 5ML DROPS", "code_information": [{"code": "MED0084", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 240.92, "discounted_cash": 144.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP; SPINE INJ. 77003", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "10481801", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1933.0, "discounted_cash": 1159.8, "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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 793.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 717.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 995.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1200.39, "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": "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": 1955.0, "discounted_cash": 1173.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 802.52, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 802.52, "methodology": "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": 989.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 726.08, "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": 1006.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1214.05, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee 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schedule"}, {"payer_name": "BLUE 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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/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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 14.55, "discounted_cash": 8.73, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.22, "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": 6.16, "discounted_cash": 3.7, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.51, "methodology": "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": 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": 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": "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": "FORCEP BIPOLAR SCOVILLE 10 INCH 1.5MM TIP", "code_information": [{"code": "19-1236c", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.88, "discounted_cash": 90.53, "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": 63.94, "discounted_cash": 38.36, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 2.3MM STANDARD SMALL X-FUSE", "code_information": [{"code": "XPI003002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.17, "discounted_cash": 261.7, "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": 85.2, "discounted_cash": 51.12, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.8 X 3.2MM X 240CM RADIAL JAW 4 JUMBO NDL ORANGE", "code_information": [{"code": "M00513373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.75, "discounted_cash": 20.25, "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": 62.78, "discounted_cash": 37.67, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 7.75IN BAYONET SCOVILLE DISP", "code_information": [{"code": "19-1003C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.88, "discounted_cash": 90.53, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 8 1/2IN 0.5MM 12FT CORD HARDY BAYONET", "code_information": [{"code": "19-1230C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.45, "discounted_cash": 83.07, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR BAYONETTED STRAIGHTINSTR", "code_information": [{"code": "675.170S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5647.14, "discounted_cash": 3388.28, "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": 172.42, "discounted_cash": 103.45, "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": 39.08, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS RADIAL JAW 4 LC W/NEEDLE 240CM BX 5", "code_information": [{"code": "M00513333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.62, "discounted_cash": 50.77, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 132MM POINTS BROAD RATCHET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "398.41.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 925.02, "discounted_cash": 555.01, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REMOVAL FOR BROKEN SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "398.65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1845.48, "discounted_cash": 1107.29, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 240 CM 2.8MM 2.4MM BX HOT CUP PRCS BITE RJ 4 DISP", "code_information": [{"code": "M00515031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.25, "discounted_cash": 74.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 240 CM HOT BIOPSY RADIAL JAW W/ NDL", "code_information": [{"code": "M00515030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.74, "discounted_cash": 125.24, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 4 ENDO BX NDL RJ", "code_information": [{"code": "M00513371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.08, "discounted_cash": 56.45, "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": 83.43, "discounted_cash": 50.06, "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": 1814.62, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 8450.0, "methodology": "fee 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": 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.59, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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 KIT STABILIT FIRST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7700.0, "discounted_cash": 4620.0, "setting": "both", "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 25208.09, "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": "FRAME 180MM SALVATION", "code_information": [{"code": "SEF99601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 820.52, "discounted_cash": 492.31, "setting": "both", "billing_class": "facility"}]}, {"description": "FRAME SALVATION 180MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SEFA1180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15140.0, "discounted_cash": 9084.0, "setting": "both", "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.11, "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": "FRAZIER SUCTION TIP 8FR", "code_information": [{"code": "166024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.47, "discounted_cash": 9.28, "setting": "both", "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS 20969", "code_information": [{"code": "20969", "type": "CPT"}, {"code": "45618522", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 698.61, "maximum": 9357.0, "gross_charge": 2117.0, "discounted_cash": 1270.2, "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": 1024.62, "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": 698.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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/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": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREIGHT CHARGE", "code_information": [{"code": "MEDFRT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FRENOPLASTY 41520", "code_information": [{"code": "41520", "type": "CPT"}, {"code": "1740087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 9357.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 9357.0, "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", "code_information": [{"code": "54164", "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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"}]}, 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"AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 2141.81, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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": 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": 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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 2123.0, "discounted_cash": 1273.8, "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": 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": 1027.53, "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 FREE W/CLOSURE DONOR SITE HEAD/CHEEK/CHIN/MOUTH/AX/GENT/HD/FT EA 20 SQ CM 15241", "code_information": [{"code": "15241", "type": "CPT"}, {"code": "2434566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 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": 1027.53, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 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3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 448.0, "discounted_cash": 268.8, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 3372.0, "discounted_cash": 2023.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION F3D CORPECROMY 14.5MM X 12MM X 48MM 7 DEGREE 3CM1412-0748", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3CM1412-0748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 70000.0, "discounted_cash": 42000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION LATERAL 18MM X 8MM X 45MM 10\u00c2\u00b0 WL1184510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WL1184510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION LATERAL 22W X 60L X 12H 8\u00c2\u00b0 62-2260-12-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-2260-12-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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": 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": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 CERVICAL POSTERIOR AND DISCECTOMY 22600", "code_information": [{"code": "22600", "type": "CPT"}, {"code": "1480966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.66, "maximum": 14796.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 2046.66, "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 SPINE LUMBAR POSTERIOR 22612", "code_information": [{"code": "22612", "type": "CPT"}, {"code": "1480968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3001.76, "maximum": 9735.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 9735.0, "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": 3001.76, "maximum": 14796.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 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 SPINE THORACIC POSTERIOR 22610", "code_information": [{"code": "22610", "type": "CPT"}, {"code": "1480971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.66, "maximum": 14796.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 2046.66, "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/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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": 9735.0, "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 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{"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": 0.51, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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 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"methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 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"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": "G7 HI-WALL ARCOMXL LNR 32MM C 010000808", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "10000808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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{"description": "GAIT BELT BLACK 60 1EA MDT821203B", "code_information": [{"code": "MDT821203B", "type": "CDM"}], "standard_charges": [{"gross_charge": 42.09, "discounted_cash": 25.25, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.68, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"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": "GARFT DERMIS ALLOPATCH 4X8CM WC0418", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "WC0418", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2339.2, "discounted_cash": 1403.52, "setting": "both", "billing_class": "facility"}]}, {"description": "GARMENT COMPR MED WHT DVT LEG THIGH LEN THREE CHMBR VINYL SCD EXPRESS DISP", "code_information": [{"code": "9530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.9, "discounted_cash": 132.54, "setting": "both", "billing_class": "facility"}]}, {"description": "GARMENT MEDLINE DVT INT CALF LG GEN2", "code_information": [{"code": "MDS601L2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.22, "discounted_cash": 32.53, "setting": "both", "billing_class": "facility"}]}, {"description": "GARMET DVT SLEEVES CALF SINGLE BLADDER HEMO-FORCE II MEDIUM 12IN-18IN CIRCUM", "code_information": [{"code": "MDS601M2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.68, "discounted_cash": 29.81, "setting": "both", "billing_class": "facility"}]}, {"description": "GAS SAMPLING LINE M M 50EA CS WHSA30MM", "code_information": [{"code": "WHSA30MM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.16, "discounted_cash": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTRECTOMY LAPAROSCOPIC-LONGITUDINAL 43775", "code_information": [{"code": "43775", "type": "CPT"}, {"code": "1480972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 366.3, "maximum": 16000.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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", "standard_charge_dollar": 537.24, "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": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 366.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRECTOMY/PARTIAL/DISTAL W/GASTRODUODENOSTOMY 43631", "code_information": [{"code": "43631", "type": "CPT"}, {"code": "1480977", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1857.24, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 1857.24, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.4, "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 BANDING LAPAROSCOPIC 43770", "code_information": [{"code": "43770", "type": "CPT"}, {"code": "1480980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 16000.0, "gross_charge": 7698.0, "discounted_cash": 4618.8, "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 WALMART ACO", "standard_charge_dollar": 16000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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", "standard_charge_dollar": 3725.83, "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": 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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 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": 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 INTUBATION AND ASPIRATION THERAPEUTIC NECESSITATING PHYSICIAN SKILL 43753", "code_information": [{"code": "43753", "type": "CPT"}, {"code": "15213990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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", "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": 4620.0, "methodology": "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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, "estimated_discounted_cash": 5092.46, "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": "GASTROPLASTY-VERTICAL BANDED 43842", "code_information": [{"code": "43842", "type": "CPT"}, {"code": "1480986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "gross_charge": 10717.0, "discounted_cash": 6430.2, "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": 5187.02, "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": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROSTOMY LAPAROSCOPIC 43653", "code_information": [{"code": "43653", "type": "CPT"}, {"code": "1480987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2723.95, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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": "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": 1301.0, "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 1211.9, "discounted_cash": 727.14, "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": 3.0, "discounted_cash": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE PACKING 2IN X 72IN VAGINAL RADIOPAQUE STRL", "code_information": [{"code": "10-026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.84, "discounted_cash": 17.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE 16-PLY 4 X 4 PRM21416CZ", "code_information": [{"code": "PRM21416CZ", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE 2X2 4PLY NS NW LF NON25224", "code_information": [{"code": "NON25224", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES-PREMIUM 4INX4IN 12-PLY NS", "code_information": [{"code": "C-NSG4412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES-PREMIUM 4INX4IN 12-PLY ST", "code_information": [{"code": "C-SG4412ZS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE X-RAY DETECTABLE 4X4 16 PLY", "code_information": [{"code": "C-XR4416S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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 DBM 5CC STIMUBLAST", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2002-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2286.0, "discounted_cash": 1371.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL DBM EXFUSE 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "EG1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL LIQUA SONIC 5L", "code_information": [{"code": "1222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.17, "discounted_cash": 42.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL ORISE SUBMUCOSAL LIFTING AGENT", "code_information": [{"code": "M00519200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 643.49, "discounted_cash": 386.09, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL PORT (ETHICON)", "code_information": [{"code": "HAP02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 732.2, "discounted_cash": 439.32, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL SUBMUCOSAL LIFTING AGENT ORISE M00519201", "code_information": [{"code": "M00519201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.7, "discounted_cash": 286.62, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL VOICE 1CC PROLARYN INJ IMP", "code_information": [{"code": "C1878", "type": "HCPCS"}, {"code": "8602M0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM 25X50MM", "code_information": [{"code": "MED0085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.48, "discounted_cash": 341.09, "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": 80.92, "discounted_cash": 48.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SIZE 50", "code_information": [{"code": "MED0087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.54, "discounted_cash": 33.92, "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": 26.44, "discounted_cash": 15.86, "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": 630.0, "discounted_cash": 378.0, "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": 100.0, "discounted_cash": 60.0, "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", "code_information": [{"code": "80050", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 INTELLIS ADAPT.", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42050.0, "discounted_cash": 25230.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR PULSE 16 CHANNEL 18CC 2.5 CM MAXIMUM IMPLANT DEPTH NRSTMLTR RECHARGEAB", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31980.0, "discounted_cash": 19188.0, "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": 37351.6, "discounted_cash": 22410.96, "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": 30600.0, "discounted_cash": 18360.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.26, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 2279.15, "maximum": 8450.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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": 2279.15, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 80MG/2 ML VIAL/GARAMYCIN", "code_information": [{"code": "MED0089", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "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": 33.25, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN PEDIATRIC 20MG/2ML", "code_information": [{"code": "MED0221", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.15, "discounted_cash": 4.89, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN TOP 0.1% OINT 15 GM", "code_information": [{"code": "MED0090", "type": "CDM"}], "standard_charges": [{"gross_charge": 112.55, "discounted_cash": 67.53, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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 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": 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": 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"}], "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": 117.01, "discounted_cash": 70.21, "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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 365.26, "discounted_cash": 219.16, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 34.71, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.71, "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": "GII NONPOROUS PS FEM SZ 5 LT 71420104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3640.0, "discounted_cash": 2184.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GII OXIN P/S FEM LEFT SZ 4 71421014", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8724.0, "discounted_cash": 5234.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GII OXIN P/S FEM RIGHT SZ 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"discounted_cash": 24.08, "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 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{"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": 1.8, "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": 1.8, "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": 7.1, "discounted_cash": 4.26, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN PROTECTIVE XL IMPERVIOUS SLEEVE REINFORCED POLYETHYLENE ECLIPSE", "code_information": [{"code": "DYNJP2208P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.24, "discounted_cash": 9.14, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SMART SLEEVE LG BREATHABLE IMPERVIOUS SLEEVE", "code_information": [{"code": "9011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.07, "discounted_cash": 9.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG 2XL UNREINFORCED STRL BACK DISP", "code_information": [{"code": "9575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.71, "discounted_cash": 9.43, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA EXTRA XL 50IN BLUE NON REINFORCED HOOK AND LOOP CLOSURE AAMI LEV", "code_information": [{"code": "DYNJP2004S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.15, "discounted_cash": 16.29, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL BLUE 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{"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": 1284.92, "discounted_cash": 770.95, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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"}, 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"standard_charges": [{"gross_charge": 1179.12, "discounted_cash": 707.47, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES 15CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "12700601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7012.0, "discounted_cash": 4207.2, "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": 1948.0, "discounted_cash": 1168.8, "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": 1410.32, "discounted_cash": 846.19, "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": 2004.0, "discounted_cash": 1202.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES BONE 30CC PRO OSTEON 500R", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "5RG30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2996.0, "discounted_cash": 1797.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER BABCOCK 5MM 33CM", "code_information": [{"code": "5BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.97, "discounted_cash": 124.78, "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": 243.79, "discounted_cash": 146.27, "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": 179.69, "discounted_cash": 107.81, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER LAPSCR ROT", "code_information": [{"code": "174233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.29, "discounted_cash": 392.57, "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": 57.24, "discounted_cash": 34.34, "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": 57.24, "discounted_cash": 34.34, "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": 57.24, "discounted_cash": 34.34, "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": 2476.0, "discounted_cash": 1485.6, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "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", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.09, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.78, "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", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.0, "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": 428.8, "discounted_cash": 257.28, "setting": "both", "billing_class": "facility"}]}, {"description": "GUARD TOOTH LARYNGOSCOPE NYLON LF ADLT", "code_information": [{"code": "502275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.62, "discounted_cash": 27.37, "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", "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": 4620.0, "methodology": "fee schedule"}, {"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": 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": 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"}, 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.04, "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": 217.0, "discounted_cash": 130.2, "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": 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": 80.59, "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 PINS SELF TAPPING 2.0MM 45MM LENGTH 12MM THREAD APEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5080-2-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.2, "discounted_cash": 121.92, "setting": "both", "billing_class": "facility"}]}, {"description": "HALF-PIN 2.5 X 80MM, 15MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RR251580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 136.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HALF-PIN 3.0 X 80MM, 20MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RR301580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 136.8, "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": 4172.0, "discounted_cash": 2503.2, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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. 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"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": 2793.0, "discounted_cash": 1675.8, "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": 1187.37, "discounted_cash": 712.42, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE PEEK FIXATION SYSTEM SMALL SK31", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK31", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2014.0, "discounted_cash": 1208.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND & UPPER EXTREMITIES CAP PRICING EXTREMITY-CAP-PRICE", "code_information": [{"code": "C1776", 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{"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 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{"code": "66800041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.8, "discounted_cash": 989.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE INTERPULSE W HIGH FLOW TIP 210114000", "code_information": [{"code": "210114000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.79, "discounted_cash": 243.47, "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": 1509.11, "discounted_cash": 905.47, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE PERCRESECTOR SPINEJET STERILE DISP", "code_information": [{"code": "56000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3206.0, "discounted_cash": 1923.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECEINTEGRATED 2.3MM END EFFECT ELECTRODEINSTABILITY ROTATOR CUFF REPROCESS", "code_information": [{"code": "227202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.2, "discounted_cash": 144.72, "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, 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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 OF SKIN FOR TISSUE CULTURED SKIN AUTOGRAFT; 100 SQ CM OR LESS 15040", "code_information": [{"code": "15040", "type": "CPT"}, {"code": "43014000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 1294.57, "discounted_cash": 776.74, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVESTER QUADPRO 8MM AR-2386-08", "code_information": [{"code": "AR-2386-08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1294.57, "discounted_cash": 776.74, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "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": "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": 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": 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": 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": 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": 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "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": 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": 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 22MM LEFT ARH SOLUTIONS 2 5001-0522L-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5001-0522L-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6924.76, "discounted_cash": 4154.86, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 22MM RIGHT ARH SOLUTIONS 2 5001-0522R-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5001-0522R-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10586.0, "discounted_cash": 6351.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 24MM RIGHT ARH SOLUTIONS 2 5001-0524R-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5001-0524R-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12056.0, "discounted_cash": 7233.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 3500 SERIES TRANS CONNECTOR TO 25MM-31MM TC3625-31", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3625-31", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 3500 SERIES TRANS CONNECTOR TO 30MM-36MM TC3630-36", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3630-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD DRILL DARCO ED 2.7MM BIT 77702713", "code_information": [{"code": "77702713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.75, "discounted_cash": 291.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD DRILL STEM MUC 3.0MM CANN CHARLOTTE F and A SYSTEM 44112012", "code_information": [{"code": "44112012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.34, "discounted_cash": 316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD EVOLVE 20MM 496H020", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "496H020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8854.0, "discounted_cash": 5312.4, "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": 1141.2, "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": 4272.0, "discounted_cash": 2563.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 22MM +8MM 12/14 COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71302208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2094.12, "discounted_cash": 1256.47, "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": 1981.44, "discounted_cash": 1188.86, "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": 2088.0, "discounted_cash": 1252.8, "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": 4272.0, "discounted_cash": 2563.2, "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": 7120.0, "discounted_cash": 4272.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM POSITIVE 4MM OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4272.0, "discounted_cash": 2563.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36 MM +5MM COCR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-3603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +0MM 12/14 TAPER COBALT 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"C1776", "type": "HCPCS"}, {"code": "71303608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2622.0, "discounted_cash": 1573.2, "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": 1690.0, "discounted_cash": 1014.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MMX 6MM ACTBLR SYS TYPE 1 COCR G7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-363660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "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": 3360.0, "discounted_cash": 2016.0, "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": 1902.0, "discounted_cash": 1141.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL COCR TRANSCEND 36MM SLT TAPER LONG NECK 26000027", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "26000027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL COCR TRANSCEND 36MM SLT TAPER MEDIUM NECK 26000026", "code_information": [{"code": "26000026", "type": "CDM"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "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": 1350.0, "discounted_cash": 810.0, "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": 1540.0, "discounted_cash": 924.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 38MM X 19MM X 39MM SHOULDER SYS VERSA-DIAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2900.0, "discounted_cash": 1740.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 40MM X 20MM COBALT CHROME BIO MODULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3703.0, "discounted_cash": 2221.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 41X15 LOW OFFSET AEQUALIS DWF041", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5850.0, "discounted_cash": 3510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 42MM X 18MM X 46MM SHOUDLER SYS VERSA-DIAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 42MM X 21MM X 43MM VERSA DIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 44MM X 17MM BIO MODULAR EAS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 46MM X 18MM X 53MM SHOULDER SYS VERSA-DIAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 46MM X 21MM X 50MM VERSA DIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 48MM X 24MM COBALT CHROME BIO MODULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3703.0, "discounted_cash": 2221.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 50MM X 21MM X 57MM SHOULDER SYS VERSA-DIAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL CENTERED 50MM X 19MM", "code_information": [{"code": "C1776", "type": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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": 4620.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"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": 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": 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", "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": 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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.9, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.48, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.39, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.08, "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", 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.01, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.71, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.7, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.29, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.06, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.07, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.62, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.36, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.39, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-MULTIPLE COLUMNS 46260", "code_information": [{"code": "46260", "type": "CPT"}, {"code": "1481009", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOSTASIS MATERIAL OSTENE 2.5G", "code_information": [{"code": "1503832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.63, "discounted_cash": 149.78, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 1X2 1961", "code_information": [{"code": "1961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.06, "discounted_cash": 178.84, "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": 460.15, "discounted_cash": 276.09, "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": 268.0, "discounted_cash": 160.8, "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": 245.04, "discounted_cash": 147.02, "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": 349.05, "discounted_cash": 209.43, "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": 189.24, "discounted_cash": 113.54, "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": 95.85, "discounted_cash": 57.51, "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": 178.69, "discounted_cash": 107.21, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC ABSORBL 3GM VITASURE", "code_information": [{"code": "2114-0003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.2, "discounted_cash": 370.92, "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": 502.5, "discounted_cash": 301.5, "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": 537.14, "discounted_cash": 322.28, "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": 376.79, "discounted_cash": 226.07, "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": 325.04, "discounted_cash": 195.02, "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": 376.79, "discounted_cash": 226.07, "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": 376.79, "discounted_cash": 226.07, "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": 379.56, "discounted_cash": 227.74, "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": 379.56, "discounted_cash": 227.74, "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": 452.25, "discounted_cash": 271.35, "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": 351.75, "discounted_cash": 211.05, "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": 98.09, "discounted_cash": 58.85, "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 ACUTE PROF", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "1233822", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 1329.0, "discounted_cash": 797.4, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 493.59, "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": 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": "HEP B CORE ANTIBODY IGM", "code_information": [{"code": "86705", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.18, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 39.5, "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 1000 UNITS/ML 10ML", "code_information": [{"code": "MED0393", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.49, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN 5000 UNITS/1ML VIAL", "code_information": [{"code": "MED0093", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.48, "discounted_cash": 4.49, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.2, "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": 3.0, "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": 15.4, "discounted_cash": 9.24, "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": 47.94, "discounted_cash": 28.76, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.28, "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": 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": 7.49, "discounted_cash": 4.49, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.38, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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"}], "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.79, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.85, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.49, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 157.43, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.99, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": "HEPATOTOMY RESECTION OF LIVER-PARTIAL LOBECTOMY 47120", "code_information": [{"code": "47120", "type": "CPT"}, {"code": "1481017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1036.2, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 1036.2, "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": "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": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 BALLON SPACEMAKER PRO ROUND", "code_information": [{"code": "SMBTTRNDX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.54, "discounted_cash": 798.32, "setting": "both", "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 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "HEX ROD HEX STAND 4.75 COCR 510MM", "code_information": [{"code": "14-587151CS", "type": "CDM"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 1380.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX ROD HEX STRT TI 510MM", "code_information": [{"code": "14-585151T", "type": "CDM"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 1380.0, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.2, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.31, "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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"AETNA WHOLE HEALTH", "standard_charge_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 FLOW RATE EXTENSION SET 2N3349", "code_information": [{"code": "2N3349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "discounted_cash": 2.76, "setting": "both", "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": "HINGE TOE SZ5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "64260105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2518.0, "discounted_cash": 1510.8, "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 CORE DECOMPRESSION S2325", "code_information": [{"code": "S2325", "type": "HCPCS"}, {"code": "18959542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2443.0, "discounted_cash": 1465.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_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": 452.0, "discounted_cash": 271.2, "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": 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": 167.87, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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 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 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"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. 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.08, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.4, "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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-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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 217.01, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.85, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.48, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.79, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 451.99, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.66, "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": 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"}, 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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"}, 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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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 39.09, "discounted_cash": 23.45, "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": 39.1, "discounted_cash": 23.46, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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": 39.1, "discounted_cash": 23.46, "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": 36.86, "discounted_cash": 22.12, "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": 36.86, "discounted_cash": 22.12, "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": 36.85, "discounted_cash": 22.11, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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": 39.09, "discounted_cash": 23.45, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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-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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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-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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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-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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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-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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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-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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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[{"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.67, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": "HS FIBER ULTRALOOP UHMWPE WH BLU", "code_information": [{"code": "72205445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.45, "discounted_cash": 214.47, "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 1/2 PCR", "code_information": [{"code": "87529", "type": "CPT"}, {"code": "1099839", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 232.0, "discounted_cash": 139.2, "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": 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": 86.16, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": 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", "standard_charge_dollar": 8450.0, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.18, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.7, "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": "HTLV/HIV CONFIRMJ ANTIBODY", "code_information": [{"code": "86689", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "HTO PLATE CANCELLOUS SCREW 6.5 X 60 MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13260T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172.66, "discounted_cash": 103.6, "setting": "both", "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": 8450.0, "methodology": "fee 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"}, 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72.66, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROSET XT 10CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "897010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9922.0, "discounted_cash": 5953.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROSET XT 5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "897005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2514.0, "discounted_cash": 1508.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HYLENEX 150U/ML 1ML", "code_information": [{"code": "MED0569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 170.25, "discounted_cash": 102.15, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 & SUSPENSION", "code_information": [{"code": "21685", "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": 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": "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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "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": 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": 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": 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", "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": 8450.0, "methodology": "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", "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": 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", "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": 1301.0, "methodology": "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": 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": 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", "standard_charge_dollar": 4620.0, "methodology": "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": 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": 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": 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": 4620.0, "methodology": "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": 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": 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": "HYPOCURE SINUS TARSI SZ5 IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HYP-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2154.0, "setting": "both", "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": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "HYSTEROSCOPY BIOPSY", "code_information": [{"code": "58558", "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": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "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": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE FB", "code_information": [{"code": "58562", "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": "HYSTEROSCOPY REMOVE MYOMA", "code_information": [{"code": "58561", "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": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "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": "HYSTEROSCOPY STERILIZATION", "code_information": [{"code": "58565", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "HYSTEROSCOPY WITH ENDOMETRIAL ABLATION 58563", "code_information": [{"code": "58563", "type": "CPT"}, {"code": "1481027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 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": 1827.1, "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": "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": 295.0, "discounted_cash": 177.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 109.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, 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"AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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"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": 5.35, "discounted_cash": 3.21, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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"}], 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", 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"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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 6252.0, "discounted_cash": 3751.2, "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 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"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": 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"plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", 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"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", 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"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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "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 W/BIOPSY SINGLE OR MULTI 44382", "code_information": [{"code": "44382", "type": "CPT"}, {"code": "8125380", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 9735.0, "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": 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "ILLUMINATED BLADE TIP 25MM X 1/4 (Flat Blade)", "code_information": [{"code": "14-500556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1402.0, "discounted_cash": 841.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR LIF 27436-3-S", "code_information": [{"code": "27436-3-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.5, "discounted_cash": 755.7, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "IMBIBE 2090-9028", "code_information": [{"code": "2090-9028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 781.18, "discounted_cash": 468.71, "setting": "both", "billing_class": "facility"}]}, {"description": "IMFLUOR 1ST 1ANTB STAIN PX", "code_information": [{"code": "88346", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": "IMFLUOR EA ADDL 1ANTB STN PX", "code_information": [{"code": "88350", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": 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"maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.84, "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": 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.13, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 125", "code_information": [{"code": "86304", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_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": 2990.0, "discounted_cash": 1794.0, "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": 1800.0, "discounted_cash": 1080.0, "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": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP GENZYME SYNVISC HYLAN G-F 20", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}, {"code": "58468-0090-2", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 70.12, "discounted_cash": 42.07, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP NEXA SZ 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CGT-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3792.0, "discounted_cash": 2275.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP TOE SWANSON SZ 2S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G4260102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1432.5, "discounted_cash": 859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPANT BODY REDUCTION ORTHOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44-2103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPANT TOW SWANSON FLEX HINGE SZ 2S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G2460102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1432.5, "discounted_cash": 859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPANT XWRAP-DRY 4 X 4CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "XDW-40404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5760.0, "discounted_cash": 3456.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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 FEMORAL EMPOWR 3D SZ 7 LFT NONPOROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "241-01-107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"discounted_cash": 966.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 03MM LENGTH 24MM NEXIS PS020024 PS020024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS020024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1610.0, "discounted_cash": 966.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 03X30MM NEXIS PECA PS020030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS020030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1610.0, "discounted_cash": 966.0, "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": 1740.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": 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"HCPCS"}, {"code": "42-5121-008-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6606.0, "discounted_cash": 3963.6, "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": 2068.9, "discounted_cash": 1241.34, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 12X39MM REGASPAN", "code_information": [{"code": "1-61002-1239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15780.0, "discounted_cash": 9468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 14 X 14 X 14 SPONGE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "70814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, 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3060.0, "discounted_cash": 1836.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIO COMPOSITE ACHLLES 4.75MM SPEED BRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8928BCJ", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4588.0, "discounted_cash": 2752.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIO-INDUCTIVE LARGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2169-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIO-INDUCTIVE MEDIUM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2169-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 2760.0, "setting": "both", "billing_class": "facility"}]}, 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"IMPLANT BONE 4MM TO 63MM CROSSLINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "801-75060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5076.0, "discounted_cash": 3045.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 8.0MM FULL PROFILE STEM TYPE ONE HIGH OFFSET 133 DEGREE NECK ANGLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "51-101080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 9.0MM REDUCED DIST TYPE ONE HIGH OFFSET 133 DEGREE NECK ANGLE TAPER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "51-104090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE CANCELLOUS SPONGE 26 X 19 X 7MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "804-6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.75, "discounted_cash": 449.25, "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": 4148.0, "discounted_cash": 2488.8, "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": 4940.0, "discounted_cash": 2964.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 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TRUSS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-SM0006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE SM 7MM X 7MM", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "CSTS-SM0707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 4560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE STAPLES ROTATION MEDICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2503-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE TENDON BONE W/QUAD >13MM WIDTH", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "430014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "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": 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"HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 NEUROELECTRODES", "code_information": [{"code": "64561", "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 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "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 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"code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "426-0070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1738.0, "discounted_cash": 1042.8, "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": 3808.0, "discounted_cash": 2284.8, "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": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, 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"standard_charges": [{"gross_charge": 4182.0, "discounted_cash": 2509.2, "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": 972.0, "discounted_cash": 583.2, "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": 2396.0, "discounted_cash": 1437.6, "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": 2872.0, "discounted_cash": 1723.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE SIZE 19 ANGLED TOE SMART", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "STOA-19P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2111.4, "discounted_cash": 1266.84, "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": 1432.5, "discounted_cash": 859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE SZ 30 FLEXIBLE CLASSIC GREAT TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CGT-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3440.0, "discounted_cash": 2064.0, "setting": "both", "billing_class": 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"PX02-00705-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12224.0, "discounted_cash": 7334.4, "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": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TWO-STEP HAMMERTOE 3.4 X 3.0 X 18MM 204-30-018", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "204-30-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT UNIKNEE CAP PRICE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SHOUKI", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10021.66, "discounted_cash": 6013.0, "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 VANGUARD KNEE TIBIAL 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": "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 STEINMANN PIN 2.4MM 200072", "code_information": [{"code": "200072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.55, "discounted_cash": 44.73, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "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": 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": "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": 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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "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": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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": 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": "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": 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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "65865", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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 BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 FOR TREATMENT", "code_information": [{"code": "61770", "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": "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 BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "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": 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 SPERM DUCT POUCH", "code_information": [{"code": "55605", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "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 SPINE NRV HALF SEGMNT", "code_information": [{"code": "63185", "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 TEAR DUCT OPENING", "code_information": [{"code": "68440", "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "INCISION EXTENSOR TENDON SHEATH WRIST 25000", "code_information": [{"code": "25000", "type": "CPT"}, {"code": "1481074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "INCISION FLEXOR TENDON SHEATH WRIST 25001", "code_information": [{"code": "25001", "type": "CPT"}, {"code": "10710874", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3162.0, "discounted_cash": 1897.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1530.4, "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": "INCISION LEG OR ANKLE 27607", "code_information": [{"code": "27607", "type": "CPT"}, {"code": "1954771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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 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": 4620.0, "methodology": "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 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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 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": "INCISION OF LINGUAL FRENUM 41010", "code_information": [{"code": "41010", "type": "CPT"}, {"code": "10956178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 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 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": 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": "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": 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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 THIGH TENDONS", "code_information": [{"code": "27307", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "INCISION OF URETHRA", "code_information": [{"code": "53025", "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": 6074.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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"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, "estimated_discounted_cash": 5745.56, "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": 249.74, "discounted_cash": 149.84, "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": 91.41, "discounted_cash": 54.85, "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": 249.74, "discounted_cash": 149.84, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.19, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.53, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "INFLUENZA VIRUS VACC, INACTIV, PF TV; 0.5 ML", "code_information": [{"code": "MED0879", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 166.08, "discounted_cash": 99.65, "setting": "both", "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": 1316.75, "discounted_cash": 790.05, "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", "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": 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 POST AUR. APP. TO MID CRANI. FOSS/INCL. MASTOIDECTOMY 61591", "code_information": [{"code": "61591", "type": "CPT"}, {"code": "33040435", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1768.47, "maximum": 8450.0, "gross_charge": 5359.0, "discounted_cash": 3215.4, "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": 2593.75, "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": 1768.47, "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": "INFUSE KIT BONE GRAFT SMALL 7510200", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "7510200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSE KIT BONE GRAFT X SMALL 7510100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "7510100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "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": 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": 4620.0, "methodology": "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": 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": 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": 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": "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 38765", "code_information": [{"code": "38765", "type": "CPT"}, {"code": "8387616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1036.2, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 1036.2, "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": "INGUINOFEMORAL LYMPHADENECTOMY SUPERFICIAL CLOQUETS NODE 38760", "code_information": [{"code": "38760", "type": "CPT"}, {"code": "1900990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 10808.0, "discounted_cash": 6484.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 5231.07, "methodology": "fee schedule"}, {"payer_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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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, 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"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 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"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 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 2827.0, "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": 1322.0, "discounted_cash": 793.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 5354.0, "discounted_cash": 3212.4, "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 POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2591.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "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": 1322.0, "discounted_cash": 793.2, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": 4172.0, "discounted_cash": 2503.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "67500", "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 POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 CEMENT HYDROSET 3CC 79-43903", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "79-43903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2098.12, "discounted_cash": 1258.87, "setting": "both", "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": 6640.0, "discounted_cash": 3984.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 AMNIO 100MG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "A1-5125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6240.0, "discounted_cash": 3744.0, "setting": "both", "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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 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"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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 639.84, "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": 639.84, "maximum": 8450.0, "gross_charge": 1322.0, "discounted_cash": 793.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": 1322.0, "discounted_cash": 793.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": 1322.0, "discounted_cash": 793.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 639.84, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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historical data found for payer/plan and coding 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": "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 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"methodology": "percent of total billed charges"}, {"payer_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": "51610", "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": "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": 2123.0, "discounted_cash": 1273.8, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1027.53, "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": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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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": 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"additional_payer_notes": "No historical data found for payer/plan and coding 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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 TURBINATE(S); THERAPEUTIC 30200", "code_information": [{"code": "30200", "type": "CPT"}, {"code": "45029750", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 MONOVISE 4ML HMWH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7327", "type": "HCPCS"}, {"code": "277515", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2193.75, "discounted_cash": 1316.25, "setting": "both", "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": 89.81, "discounted_cash": 53.89, "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": 87.19, "discounted_cash": 52.31, "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": 89.81, "discounted_cash": 53.89, "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": 89.81, "discounted_cash": 53.89, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 2123.0, "discounted_cash": 1273.8, "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 POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 1027.53, "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 ANKLE ARTHROGRAPHY 27648", "code_information": [{"code": "27648", "type": "CPT"}, {"code": "1700052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1179.0, "discounted_cash": 707.4, "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, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION/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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1028.5, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY TIBL 10MM X 71/75MM CRUCIATE RETAINING VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "183640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": 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"methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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+ 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1958.0, "maximum": 6074.0, "gross_charge": 4837.0, "discounted_cash": 2902.2, "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 POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2341.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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 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": 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": 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 2.4MM AR-1204F-24I", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-1204F-24I", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 241.2, "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": 1350.0, "discounted_cash": 810.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 36MM X 56MM 10 HOOD ACTBLR CUP SYS HIGHLY CROSS LINKED UHMWPE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1008-0-3656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ANKLE JET X 75 X 174 X 249MM EX-FIXATION CENTRAL BODY LONG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71051043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6850.8, "discounted_cash": 4110.48, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "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 ARTC 6-7 E-F 10MM KN RT VIVACIT-E PERSONA STRL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5221-007-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6606.0, "discounted_cash": 3963.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ARTC 8-11 E-F 10MM KN RT VIVACIT-E PERSONA STRL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5221-008-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6606.0, "discounted_cash": 3963.6, "setting": "both", "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": 4572.0, "discounted_cash": 2743.2, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 CUSHION STANDARD PRONEVIEW", "code_information": [{"code": "D28503CE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 DISHED SZ 1 - 2 15MM CROSS LINKED POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4572.0, "discounted_cash": 2743.2, "setting": "both", "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 E-PLUS SIZE 5 10MM EMPOWR 3D KNEE TIBIAL 341-10-705", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-10-705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 EMPOWR 3D E PLUS 14MM 7 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-14-707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT EMPOWR 3D KNEE SIZE 4 RIGHT 16MM 342-16-704", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-16-704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT EMPOWR 3D KNEE TIBIAL E-PLUS SIZE 3 10MM 342-10-703", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-10-703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT EMPOWR 3D KNEE TIBIAL SIZE 11R 14MM 342-14-711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-14-711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT EMPOWR 3D KNEETM SIZE 4 RIGHT 10MM 342-10-704", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-10-704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "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": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EIS6S10L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FEMORAL KNEE SIZE 5 LFT HEAD LEGION CRUCIATE NARROW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71933642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11380.0, "discounted_cash": 6828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FIXATION X-FUSE 0 DEGREE SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXF-XS0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2556.0, "discounted_cash": 1533.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FIXATION X-FUSE 15 DEGREE SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"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 HIGH FLEX SZ 1 - 2 11MM POST STABELISED XLINK POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2067.14, "discounted_cash": 1240.28, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HIGH FLEX SZ 1 - 2 13MM POST STABELISED XLINK POLYEHTYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4104.0, "discounted_cash": 2462.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HIGH FLEX SZ 3 - 4 18MM POST STABELISED XLINK POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4104.0, "discounted_cash": 2462.4, "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": 2400.0, "discounted_cash": 1440.0, "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 INTERBODY DEVICE W/ANT. 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"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": "INSERT KIT PF KNEE REVISION A 464502", "code_information": [{"code": "464502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7819.09, "discounted_cash": 4691.45, "setting": "both", "billing_class": "facility"}]}, {"description": 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "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": 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": "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": 4082.0, "discounted_cash": 2449.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MULTI-COMP PENIS PROS", "code_information": [{"code": "54405", "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": 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 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 BONE CAVITY", "code_information": [{"code": "36680", "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 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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4824.0, "discounted_cash": 2894.4, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 PERFORM HUMERAL SYSTEM REVERSED DWS1363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 SCORPIO TOTAL STABILIZER 16MM #5 TS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "72-4-0516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4984.0, "discounted_cash": 2990.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SELF-CONTD PROSTHESIS", "code_information": [{"code": "54401", "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": 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 SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "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": 3365.0, "methodology": "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 SHOULDER REVERSED FLEX 36MM +6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF361B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2017.0, "discounted_cash": 1210.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SMALL SOCKET 32MM 508-03-032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-03-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SMALL SOCKET 32MM 509-03-432", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-03-432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1486.0, "discounted_cash": 891.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SOCKET SMALL 32MM SEMI CONSTRAINED E-PLUS 509-03-032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-03-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "INSERT SPINE FIXATION 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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 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": 4848.0, "discounted_cash": 2908.8, "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": 4848.0, "discounted_cash": 2908.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 RIGHT 13MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4848.0, "discounted_cash": 2908.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 RIGHT 18MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "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": 4848.0, "discounted_cash": 2908.8, "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": 1680.0, "discounted_cash": 1008.0, "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": 1680.0, "discounted_cash": 1008.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 RIGHT 18MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4848.0, "discounted_cash": 2908.8, "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": 4572.0, "discounted_cash": 2743.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 4 EMPOWR SD KNEE TIBIAL 341-19-704", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-19-704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "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 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"code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-12-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "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": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ATTUNE CR RP SZ 4 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-30-410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5488.0, "discounted_cash": 3292.8, "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": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL EMPOWR 3D 10MM E-PLUS RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-10-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL EMPOWR 3D KNEE E-PLUS 4 RIGHT 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-14-704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL EMPOWR 3D KNEE E-PLUS 5 RIGHT 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": 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3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL PCL SUB VITE RT SZ 3-4 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2144-0-3410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SIZE 2 8MM 347-08-702", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "347-08-702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5900.0, "discounted_cash": 3540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SIZE 3 12MM 342-12-703", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-12-703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": 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SZ 6 12MM LEFT EPLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-12-706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ 6 EMPOWR 3D E-PLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-14-706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ 8 12MM LEFT EPLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-12-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "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": 4800.0, "discounted_cash": 2880.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 1 TO 2 9MM CONSTRAINED LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3537.36, "discounted_cash": 2122.42, "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": 4572.0, "discounted_cash": 2743.2, "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": 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"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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 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": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK SPHINCTER", "code_information": [{"code": "53445", "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": 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 UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "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": 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": "INSERT X3 2/9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "X3INSERT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "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": 2881.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 7698.0, "discounted_cash": 4618.8, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3725.83, "methodology": "fee schedule"}, {"payer_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 LAPAROSCOPIC 49324", "code_information": [{"code": "49324", "type": "CPT"}, {"code": "1481142", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 6457.0, "discounted_cash": 3874.2, "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": 3125.18, "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": "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": 4172.0, "discounted_cash": 2503.2, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 FEEDING TUBE-PERCUTANEOUS W/FLUOROSCOPY 49440", "code_information": [{"code": "49440", "type": "CPT"}, {"code": "1481144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "INSERTION GASTROJEJUNOSTOMY TUBE-PERCUTANEOUS W/FLUOROSCOPY 49441", "code_information": [{"code": "49441", "type": "CPT"}, {"code": "1481145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 5962.0, "discounted_cash": 3577.2, "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": 2885.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "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": 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{"payer_name": "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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST 11960", "code_information": [{"code": "11960", "type": "CPT"}, {"code": "23886349", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": "INSERTION OF WIRE OR PIN W/ APPLICATION 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"standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER 36569", "code_information": [{"code": "36569", "type": "CPT"}, {"code": "1481157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "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, 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OR OLDER 36573", "code_information": [{"code": "36573", "type": "CPT"}, {"code": "45432576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5950.0, "discounted_cash": 3570.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2879.8, "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": "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": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 9735.0, "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": 702.5, "discounted_cash": 421.5, "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": 1379.88, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "setting": "both", 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "methodology": "fee schedule"}, {"payer_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 VASCULAR PEDICLE TO CARPAL BONE 25430", "code_information": [{"code": "25430", "type": "CPT"}, {"code": "1481162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5627.0, "discounted_cash": 3376.2, "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": 2723.46, "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": 9357.0, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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 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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 AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "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 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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", "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 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": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "INSPACE US MEDIUM 0131", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12800.0, "discounted_cash": 7680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INST DILATORS SAFE OP AIX1330-S", "code_information": [{"code": "AIX1330-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2902.58, "discounted_cash": 1741.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INST FILLER DELIVERY AFFIRM PACK PREMER", "code_information": [{"code": "658.601S.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.5, "discounted_cash": 755.7, "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": 1247.64, "discounted_cash": 748.58, "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": 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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 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": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 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"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": 308.67, "discounted_cash": 185.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BONE T TOOL FOR RX FIX RX FIX", "code_information": [{"code": "Mar-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 775.56, "discounted_cash": 465.34, "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": 79.05, "discounted_cash": 47.43, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CNULA 7MM X 75MM THRD SHLDR FOR GENERAL ARTHROSCOPIC SURG USE CLEAR", 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"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": 452.25, "discounted_cash": 271.35, "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": 907.63, "discounted_cash": 544.58, "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": 139.73, "discounted_cash": 83.84, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT DRIVER UNIVERSAL T20 QUICK CONNECT", "code_information": [{"code": 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"discounted_cash": 106.53, "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": 983.5, "discounted_cash": 590.1, "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": 104.41, "discounted_cash": 62.65, "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": 73.33, "discounted_cash": 44.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT JAW SMALL 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"272", "type": "RC"}], "standard_charges": [{"gross_charge": 5081.05, "discounted_cash": 3048.63, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PEDIGUARD 4MM CLASSIC", "code_information": [{"code": "P1-AU411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4992.3, "discounted_cash": 2995.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT POSITION PIN CKW09001", "code_information": [{"code": "CKW09001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.75, "discounted_cash": 291.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PREP+ CARTRIDGE BONE MILL SYSTEM 5420-PRP-000", "code_information": [{"code": "5420-PRP-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.04, "discounted_cash": 982.82, "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": 593.98, "discounted_cash": 356.39, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 15MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "623.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3496.0, "discounted_cash": 2097.6, "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": 1432.69, "discounted_cash": 859.61, "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": 803.66, "discounted_cash": 482.2, "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": 593.98, "discounted_cash": 356.39, "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": 593.98, "discounted_cash": 356.39, "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": 593.98, "discounted_cash": 356.39, "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": 547.95, "discounted_cash": 328.77, "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": 547.95, "discounted_cash": 328.77, "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": 593.98, "discounted_cash": 356.39, "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": 547.95, "discounted_cash": 328.77, "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": 593.98, "discounted_cash": 356.39, "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": 593.98, "discounted_cash": 356.39, "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": 490.48, "discounted_cash": 294.29, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SEALING 10MM VESSEL HND CONTROL LIGASURE", 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"facility"}]}, {"description": "INSTRUMENT TRACKER ENT", "code_information": [{"code": "9733533XOM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 241.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT VESSEL LOOPS 0.8 X 762MM 011303PBX", "code_information": [{"code": "11303PBX", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.14, "discounted_cash": 5.48, "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": 6.21, "discounted_cash": 3.73, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENTATION SINGLE USE STERILE", "code_information": [{"code": "MTK-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1264.5, "discounted_cash": 758.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMETN BROACH DIGIFUSE DF SERIES", "code_information": [{"code": "DF2670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.9, "discounted_cash": 320.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULATED DILATOR", "code_information": [{"code": "ML-0441S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3377.75, "discounted_cash": 2026.65, "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": 4.03, "discounted_cash": 2.42, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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"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, 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AB164012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23900.0, "discounted_cash": 14340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF 25MM X 35MM 15DEG 3AF2535-1512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY POROUS COATED 10 X 27 X 12 P11027-512", "code_information": [{"code": "P11027-512", "type": "CDM"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY TO POROUS SYSTEM 14DX16WX7H 6\u00c2\u00b0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108N1407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 2580.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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"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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "INTERLINK EXTENSION SET 2 INJSITES 20\" 2C6606", "code_information": [{"code": "2C6606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.26, "discounted_cash": 4.96, "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 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{"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": 2123.0, "discounted_cash": 1273.8, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1027.53, "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 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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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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", 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"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 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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": "INTRADISCAL STERILE SHIM BATALLION LATERAL", "code_information": [{"code": "27435-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 491.75, "discounted_cash": 295.05, "setting": "both", "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": 25.88, "discounted_cash": 15.53, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "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 ID OF SENTINEL LYMPH NODE W/INJ RADIOACTIVE DYE 38900", "code_information": [{"code": "38900", "type": "CPT"}, {"code": "1643981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3019.0, "discounted_cash": 1811.4, "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": 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": 1461.19, "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": "INTRAOPERATIVE NEUROPHYSIOLOGY TESTING 95920", "code_information": [{"code": "1618455", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 702.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 305.0, "discounted_cash": 183.0, "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": [{"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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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{"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2989.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 235.83, "discounted_cash": 141.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER LEAD UROLOGY THERAPY INTERSTIM", "code_information": [{"code": "79701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER MIS-6F11 CF MICROSHEATH MIS-6F11", "code_information": [{"code": "MIS-6F11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.28, "discounted_cash": 64.97, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER NEEDLE 11G X 4.5IN BLUNT STYLET 11G ASPIRATION CANNULA 14G SYRINGE 10ML", "code_information": [{"code": "74219-07M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3423.55, "discounted_cash": 2054.13, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SHEATH 5FR 25 CM SMOOTH TRANSITION WITHOUT GUIDEWIRE SUPERSHEATH", "code_information": [{"code": "M00115730B1", "type": "CDM"}], "standard_charges": [{"gross_charge": 87.42, "discounted_cash": 52.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SHEATH SET CLOSUREFAST 7F X 11CM MIS-7F11", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "MIS-7F11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.28, "discounted_cash": 64.97, "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": 235.83, "discounted_cash": 141.5, "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": 30.52, "discounted_cash": 18.31, "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": 30.08, "discounted_cash": 18.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER VASCULAR 5FR X 21GA X 7 X 10CM ECHO NITINOL SET MICRO", "code_information": [{"code": "KIT-038-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.89, "discounted_cash": 67.73, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 3775.0, "discounted_cash": 2265.0, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1827.1, "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 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", "standard_charge_dollar": 1301.0, "methodology": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_dollar": 4620.0, "methodology": "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", "standard_charge_dollar": 8450.0, "methodology": "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": 13239.96, "methodology": "fee schedule"}, {"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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"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": 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": 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": "IOBP, CORE DECOMPRESSION AND DELIVERY KIT", "code_information": [{"code": "ABS-2000-OT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1427.36, "discounted_cash": 856.42, "setting": "both", "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": 70.04, "discounted_cash": 42.02, "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": 55.3, "discounted_cash": 33.18, "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": 24.85, "discounted_cash": 14.91, "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": 49.02, "discounted_cash": 29.41, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPIDINE 0.5% OPHTHALMIC 5ML", "code_information": [{"code": "MED0105", "type": "CDM"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IOVERA 307 SMART TIPS 3 X 6.99MM FOCUSED COLD THERAPY", "code_information": [{"code": "STT0513-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 674.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IOVERA CARTRIDGES 20-PACK", "code_information": [{"code": "CRX0111-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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"}], 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"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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "IRIDECTOMY PERIPHERAL FOR GLAUCOMA 66625", "code_information": [{"code": "66625", "type": "CPT"}, {"code": "1481167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 2989.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "IRIDECTOMY WITH CYCLECTOMY 66605", "code_information": [{"code": "66605", "type": "CPT"}, {"code": "1481170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 9357.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 9357.0, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 10.64, "discounted_cash": 6.38, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 OF BLADDER", "code_information": [{"code": "51700", "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": 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", 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"standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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{"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, 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"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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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": 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": 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": 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 1MM X 500MM TAPPERED TIP", "code_information": [{"code": "647.009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.36, "discounted_cash": 263.02, "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": 106.6, "discounted_cash": 63.96, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE NITINOL 500MM", "code_information": [{"code": "S100241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.4, "discounted_cash": 289.44, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE S/N 1.3MM", "code_information": [{"code": "Dec-39", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.09, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .035\" 6IN SINGLE TROCAR WITH ROUND END", "code_information": [{"code": "KI-71-177", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.96, "discounted_cash": 10.18, "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": 65.1, "discounted_cash": 39.06, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MXM-040-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .094 X 6 330-24-004", "code_information": [{"code": "330-24-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.25, "discounted_cash": 150.75, "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": 60.0, "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": 100.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .8MM", "code_information": [{"code": "IFI-491414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 595.72, "discounted_cash": 357.43, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .9MM X 150MM", "code_information": [{"code": "DSDS1009S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.1, "discounted_cash": 46.86, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.035\" 6IN SINGLE TROCAR WITH ROUND END", "code_information": [{"code": "KI-71-184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.96, "discounted_cash": 10.18, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.28X6 KM172-16-28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-16-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4.84, "discounted_cash": 2.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 127MM DOUBLE TROCAR KWIR-DT-09127", "code_information": [{"code": "KWIR-DT-09127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.3, "discounted_cash": 97.98, "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": 52.0, "discounted_cash": 31.2, "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": 120.7, "discounted_cash": 72.42, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X 127MM DOUBLE TROCAR KWIR-DT-11127", "code_information": [{"code": "KWIR-DT-11127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.3, "discounted_cash": 97.98, "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": 42.0, "discounted_cash": 25.2, "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": 163.3, "discounted_cash": 97.98, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X 70MM HEADLESS COMPRESSION", "code_information": [{"code": "11008526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 85.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.0 WIRGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4411-2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.35, "discounted_cash": 53.01, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1 IMD-001000003", "code_information": [{"code": "IMD-001000003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1 IMD-00100003", "code_information": [{"code": "IMD-00100003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1 X 100MM", "code_information": [{"code": "2228611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"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, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "code_information": [{"code": "50575", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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"}], "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": 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": 8450.0, "methodology": "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": 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", "standard_charge_dollar": 4620.0, "methodology": "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": 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": 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": "KIT 3.5 NX INSTRUMENT 1/PKG STERILE NXI35S", "code_information": [{"code": "NXI35S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.55, "discounted_cash": 2466.33, "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": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 5CC END-DELIVERY 11GA 120MM SCP PF KNEE 464503", "code_information": [{"code": "464503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7819.09, "discounted_cash": 4691.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 6.5MM HEADED IMPLANT PREP INCLUDING REAMER", "code_information": [{"code": "1456-6565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.78, "discounted_cash": 889.67, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 8MM SINGLE USE OATS DISPOSABLE ABS-8981-08S", "code_information": [{"code": "ABS-8981-08S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1613.53, "discounted_cash": 968.12, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACC PORTAL ORTHO SURG W/ LOW PROFILE DRILL AND EZ SHUTTLE SUT LOOP 10 MM APE", "code_information": [{"code": "CM-7610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 844.85, "discounted_cash": 506.91, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACC W/ FOUR LNG SET SCREW FOUR SHRT SET SCREW AND 2 HEX WRENCH SZ 2", "code_information": [{"code": "3550-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 72.0, "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": 6583.75, "discounted_cash": 3950.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS LATERAL", "code_information": [{"code": "8700-9112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4158.64, "discounted_cash": 2495.18, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS PEDICLE SCREW REVERE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "624.027S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4316.65, "discounted_cash": 2589.99, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS SPINAL FOR MARS 3V RETRACTOR SYS DISP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "698.600S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9920.0, "discounted_cash": 5952.0, "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": 174.2, "discounted_cash": 104.52, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCUFILL PF BSM 206150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7658.88, "discounted_cash": 4595.33, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCUPORT SIDE SCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6780.0, "discounted_cash": 4068.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACP MAX PRP SYSTEM (W/ACDA) ABS-10015", "code_information": [{"code": "ABS-10015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 837.66, "discounted_cash": 502.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACP+ACD-A ABS-10011T", "code_information": [{"code": "ABS-10011T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.9, "discounted_cash": 392.94, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADIPOSE TISSUE HARVESTING ABS10055", "code_information": [{"code": "ABS10055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.06, "discounted_cash": 319.84, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADM 10 GTT 170UM 80IN Y SLD CLMP BIFUR FLTR BLD TRNSF", "code_information": [{"code": "12435-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.4, "discounted_cash": 14.04, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMINISTRATION BASIC", "code_information": [{"code": "DYKD2001A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.19, "discounted_cash": 4.31, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSION - 8 PIECE GS90ADM6A", "code_information": [{"code": "GS90ADM6A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.09, "discounted_cash": 8.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSION W/ STANDARD WATER PITCHER", "code_information": [{"code": "DYKD10021A1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.94, "discounted_cash": 10.16, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMIT MAUVE GEN 500 ML EMESIS BASIN 4OZ HND AND BODY LOTION 4OZ MOUTHWASH PI", "code_information": [{"code": "DYKD1002A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.52, "discounted_cash": 9.91, "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": 1152.1, "discounted_cash": 691.26, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ALLOGRAFT OATS DISPOSABLE 18MM ABS-4057D-18", "code_information": [{"code": "ABS-4057D-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2978.83, "discounted_cash": 1787.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AMBIT PAIN CONTROL 220568", "code_information": [{"code": "220568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.82, "discounted_cash": 279.49, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AMBIT PAIN CONTROL W/ BUTTON GUARD", "code_information": [{"code": "220537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "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": 106.5, "discounted_cash": 63.9, "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": 268.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTHROSCOPIC INSTRUMENTS DISP", "code_information": [{"code": "2516-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 337.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ASPIRATION BONE MARROW ONE BONE MARROR ASPIRATION NDL ONE 60CC SYRNG ONE PRE", "code_information": [{"code": "AR-1101DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 441.68, "discounted_cash": 265.01, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ASSEMBLY BULB BLADDER INSUFFLATION UNIV DISP STRL", "code_information": [{"code": "D30200-210S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.46, "discounted_cash": 75.28, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AUTOPLEX W / VERTAPLEX HV 0406-687-000", "code_information": [{"code": "406-687-000", "type": "CDM"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 870.0, "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": 2543.05, "discounted_cash": 1525.83, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BEDSIDE COLON ENDOSCOPY", "code_information": [{"code": "END449846A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.39, "discounted_cash": 20.63, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BEDSIDE EGD ENDOSCOPY", "code_information": [{"code": "EN1449846A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.2, "discounted_cash": 24.72, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIO BONE PREP 0206710000", "code_information": [{"code": "206710000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.98, "discounted_cash": 165.59, "setting": 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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": "KNEETM DJO EMPOWR FIN BP NP 4L 351-01-104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "351-01-104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE BAYONET DISP", "code_information": [{"code": "1564-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.81, "discounted_cash": 614.89, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE BAYONETED SHEATHED 180MM", "code_information": [{"code": "1587-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1832.0, "discounted_cash": 1099.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE HIP BANANA BLADE CURVED", "code_information": [{"code": "7210758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.68, "discounted_cash": 287.81, "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": 1109.95, "discounted_cash": 665.97, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE SURGICAL DISP", "code_information": [{"code": "1600-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.6, "discounted_cash": 741.96, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER/SUTURE CUTTER & SLOTTED CANNULA SET 2-0 4721", "code_information": [{"code": "4721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.6, "discounted_cash": 269.76, "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": 1138.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KOVER PROBE W/STERILE GEL 5X96 INCH", "code_information": [{"code": "20-P3D596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 .6 100MM A-504.90/1", "code_information": [{"code": "A-5040.90/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.3, "discounted_cash": 55.38, "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": 64.0, "discounted_cash": 38.4, "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": 52.0, "discounted_cash": 31.2, "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": 38.0, "discounted_cash": 22.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.4X150MM TROCAR/SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGK0214150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 56.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.6MM", "code_information": [{"code": "NK01161S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.1, "discounted_cash": 46.86, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE NITINOL AZA026500", "code_information": [{"code": "AZA026500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.8, "discounted_cash": 217.08, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE SMOOTH 2.0MM", "code_information": [{"code": "KW20SS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.92, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRES BLUNT TIP LANX", "code_information": [{"code": "8734-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "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": 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": "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": 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": "KYPHON BONE CEMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO1B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.24, "discounted_cash": 154.94, "setting": "both", "billing_class": "facility"}]}, {"description": "Ketones Urine", "code_information": [{"code": "84600", "type": "CPT"}, {"code": "633769", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 295.0, "discounted_cash": 177.0, "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 WALMART ACO", "standard_charge_dollar": 24.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.63, "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": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 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": 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 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": 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 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": 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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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 PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "L145 ENTERO VU 24% 600ML", "code_information": [{"code": "901407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.67, "discounted_cash": 50.8, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINA OTOLOGIC 2.5 CM X 2.5 CM HYALURONIC ACID EPIFILM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "14-17000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.06, "discounted_cash": 103.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMINECTOMY ARM CRADLE FOAM POSITIONER", "code_information": [{"code": "FP-LARMC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.81, "discounted_cash": 14.29, "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": 3001.76, "maximum": 9735.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "setting": "both", "payers_information": 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"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": 2723.95, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "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": 9735.0, "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": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMP REPLACE 6 VOLT HALOGEN FOR USE W/ 78010 ILLUMINATION SYS", "code_information": [{"code": "7800-U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.12, "discounted_cash": 28.27, "setting": "both", "billing_class": "facility"}]}, {"description": "LANX CAGE VBR MED CURV 25 X 10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8859-2510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12900.0, "discounted_cash": 7740.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LANX K-WIRES MIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7706-1005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 132.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LANX SCREW MIS 6.5 X 40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7716-6540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5060.0, "discounted_cash": 3036.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LANX SCREW MIS 6.5 X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7716-6545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5060.0, "discounted_cash": 3036.0, "setting": "both", "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 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": 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 5892.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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/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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP 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": 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.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": 3001.76, "maximum": 11473.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": "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": 3001.76, "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": 3001.76, "maximum": 11473.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": "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": 3001.76, "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": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 9735.0, "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": 2723.95, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 2723.95, "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", 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2723.95, "methodology": "fee schedule"}, {"payer_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, 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 3001.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": 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{"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": 3001.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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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": 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 RENAL CYST", "code_information": [{"code": "50541", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", 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"methodology": "fee schedule"}, {"payer_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": "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 DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "LAPARO LIGATE SPERMATIC VEIN", "code_information": [{"code": "55550", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "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": 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": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "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": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "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 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "LAPAROSCOPE WARMER DISPOSABLE STERILE", "code_information": [{"code": "1314DLW510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.87, "discounted_cash": 28.12, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC ADRENALECTOMY 60650", "code_information": [{"code": "60650", "type": "CPT"}, {"code": "1481238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.66, "maximum": 9357.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 2046.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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 MYOMECTOMY 250 G OR LESS 58545", "code_information": [{"code": "58545", "type": "CPT"}, {"code": "1481237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2967.88, "maximum": 9357.0, "gross_charge": 6132.0, "discounted_cash": 3679.2, "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": 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": 2967.88, "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 NEPHRECTOMY", "code_information": [{"code": "50546", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC REMOVAL/REPLACEMENT ADJUSTABLE GASTRIC RESTRICTIVE COMPONENT DEVICE 43773", "code_information": [{"code": "43773", "type": "CPT"}, {"code": "1481824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 16000.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 WALMART ACO", "standard_charge_dollar": 16000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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", "standard_charge_dollar": 537.24, "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": 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": "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": 7698.0, "discounted_cash": 4618.8, "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": 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": "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": 3725.83, "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": 3001.76, "maximum": 11473.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "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": 1827.1, "maximum": 9357.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1827.1, "methodology": "fee schedule"}, {"payer_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": 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": 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": 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{"payer_name": "AETNA", "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 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"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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 PYELOPLASTY", "code_information": [{"code": "50544", "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 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"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": 1379.88, "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-COLECTOMY-TOTAL-ABDOMINAL 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"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": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 700.59, "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": "LAPAROSCOPY-ENTERECTOMY-RESECTION SMALL INTESTINE-SINGLE RESECTION & ANASTOMOSIS 44202", "code_information": [{"code": "44202", "type": "CPT"}, {"code": "1482037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1355.64, "maximum": 9357.0, "gross_charge": 4108.0, "discounted_cash": 2464.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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", "standard_charge_dollar": 1988.27, "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": 1355.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY-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": 7698.0, "discounted_cash": 4618.8, "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": 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": 3725.83, "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": "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 CX- NUETRAL, LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-LPX0L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5590.0, "discounted_cash": 3354.0, "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": 9120.0, "discounted_cash": 5472.0, "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": 956.0, "discounted_cash": 573.6, "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": 9120.0, "discounted_cash": 5472.0, "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": 1091.66, "discounted_cash": 655.0, "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": 190.92, "discounted_cash": 114.55, "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": 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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "UHC", "standard_charge_dollar": 9735.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 30.8, "discounted_cash": 18.48, "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": 27.63, "discounted_cash": 16.58, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARNGOSCOPE NON STERILE SPECTRUM LOPRO S3 0270-1078", "code_information": [{"code": "270-1078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.9, "discounted_cash": 80.94, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYGOSCOPE LOPRO S3", "code_information": [{"code": "574-0194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.23, "discounted_cash": 84.14, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYGOSCOPE LOPRO S4", "code_information": [{"code": "574-0195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.16, "discounted_cash": 83.5, "setting": "both", "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": 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": "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": 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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": 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": 9357.0, "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": 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": 9357.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": 4620.0, "methodology": "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": "LARYNGOSCOPE OPTICAL SZ 2 SM AIRTRAQ DISP REUSE", "code_information": [{"code": "ATQ-021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.38, "discounted_cash": 165.83, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE OPTICAL SZ 3 REG AIRTRAQ", "code_information": [{"code": "ATQ-011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.38, "discounted_cash": 165.83, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE SPECTRUM LOPRO S4 0270-1079", "code_information": [{"code": "270-1079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.9, "discounted_cash": 80.94, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE VIDEO LOPRO SZ 3", "code_information": [{"code": "270-0938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.86, "discounted_cash": 60.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE VIDEO LOPRO SZ 4", "code_information": [{"code": "270-0939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.9, "discounted_cash": 80.94, "setting": "both", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "setting": "both", 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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. 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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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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/ 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": 1719.0, "maximum": 8450.0, "gross_charge": 12448.0, "discounted_cash": 7468.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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, 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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"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": "LASER HOLMIUM HIGH POWER 613", "code_information": [{"code": "613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 910.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER SURGERY ANAL LESIONS", "code_information": [{"code": "46917", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 90 DEG TIP ROTATION AR-6065-90", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-6065-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.4, "discounted_cash": 227.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LASSO SUT 25 DEGREE TIGHT CURVE LFT SUTLASSO QUICKPASS LASSO", "code_information": [{"code": "AR-6068-25TL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 487.37, "discounted_cash": 292.42, "setting": "both", "billing_class": "facility"}]}, {"description": "LASSO SUT 25 DEGREE TIGHT CURVE RIGHT QUICKPASS LASSO", "code_information": [{"code": "AR-6068-25TR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.6, "discounted_cash": 269.76, "setting": "both", "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": 487.37, "discounted_cash": 292.42, "setting": "both", "billing_class": "facility"}]}, {"description": "LASSO SUT CRESCENT QUICKPASS LASSO", "code_information": [{"code": "AR-6068C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.88, "discounted_cash": 209.33, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL IMPLANT 22 X 50 X 8DEG MATRIC 62-2250-10-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-2250-10-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18400.0, "discounted_cash": 11040.0, "setting": "both", "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": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "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": "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": 3140.0, "discounted_cash": 1884.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 6600.0, "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": 450.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT- SENZA OMNIA IPG + 2 LEAD1058-50 OR 70S 1080-PERC", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "1080-PERC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47000.0, "discounted_cash": 28200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD WIRE DISPOSABLE", "code_information": [{"code": "302775-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LEADWIRE MULTISTAGE CADWELL", "code_information": [{"code": "302775-200-2017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 491.75, "discounted_cash": 295.05, "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": 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-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": 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": 9357.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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-3/> PIECE W/O GRAFT", "code_information": [{"code": "21143", "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": "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 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": 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": 9357.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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": "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", 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"standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 DRAPE DISPOSABLE 20 CS 8420", "code_information": [{"code": "8420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.1, "discounted_cash": 6.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION HK GD MOTION ISRT 18MM SZ 2-3 RT 71423348", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2719.92, "discounted_cash": 1631.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION HK TIBIAL BASE SZ 3 RIGHT 71421903", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5181.32, "discounted_cash": 3108.79, "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", 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total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.5, "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": 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 SCW LWDG S4 10D X 5P 71421733", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71421733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3059.82, "discounted_cash": 1835.89, "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": 4302.0, "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 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "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": "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": 4620.0, "methodology": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 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"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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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"LGN CK/HK FULL TIB WDGE SZ3-4 15MM 71423078", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2056.8, "discounted_cash": 1234.08, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN CK/HK FULL TIB WDGE SZ5-6 10MM 71423075", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71423075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4117.5, "discounted_cash": 2470.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN CK/HK HEMI SZ 3-4 LM/RL 10MM 71423433", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3675.0, "discounted_cash": 2205.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN HK DIS FEM WEDGE SZ 7 20M 71422107", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1359.96, "discounted_cash": 815.98, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN HK FEM ASSEMBLY SZ 7 RT 71421367", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9171.28, "discounted_cash": 5502.77, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN OX CONSTRAINED FEM 7 LT 71421167", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN OX CONSTRAINED FEM 7 RT 71421177", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15090.0, "discounted_cash": 9054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN POROUS CR FEM SZ 5L 71423245", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8376.0, "discounted_cash": 5025.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN POS FEM WDG 5MM SZ5-6 LNG 71421805", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2616.0, "discounted_cash": 1569.6, "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": 15.81, "discounted_cash": 9.49, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 20ML VIAL", "code_information": [{"code": "MED0113", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.06, "discounted_cash": 6.04, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 30ML VIAL", "code_information": [{"code": "MED0114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.28, "discounted_cash": 7.37, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 50ML VIAL", "code_information": [{"code": "MED0115", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.69, "discounted_cash": 22.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% INJ 2ML", "code_information": [{"code": "MED0110", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.81, "discounted_cash": 8.29, "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": 10.84, "discounted_cash": 6.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% PF 30ML", "code_information": [{"code": "MED0376", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.28, "discounted_cash": 7.37, "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": 7.87, "discounted_cash": 4.72, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 10ML VIAL", "code_information": [{"code": "MED0118", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.74, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 20ML VIAL", "code_information": [{"code": "MED0119", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "discounted_cash": 4.27, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 50ML VIAL", "code_information": [{"code": "MED0120", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.74, "discounted_cash": 7.64, "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": 7.15, "discounted_cash": 4.29, "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": 29.82, "discounted_cash": 17.89, "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": 10.8, "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": 17.04, "discounted_cash": 10.22, "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": 16.06, "discounted_cash": 9.64, "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": 11.24, "discounted_cash": 6.74, "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": 8.99, "discounted_cash": 5.39, "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": 12.95, "discounted_cash": 7.77, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1.5% PF INJ 30ML", "code_information": [{"code": "MED0127", "type": "CDM"}], "standard_charges": [{"gross_charge": 46.92, "discounted_cash": 28.15, "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": 8.27, "discounted_cash": 4.96, "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": 20.88, "discounted_cash": 12.53, "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": 15.06, "discounted_cash": 9.04, "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": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% PF 10ML", "code_information": [{"code": "MED0129", "type": 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"discounted_cash": 4440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGAMENT PATELLAR HEMI", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "HPL-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 3060.0, "setting": "both", "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": 6202.0, "discounted_cash": 3721.2, "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 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"methodology": "fee schedule"}, {"payer_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": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 9735.0, "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": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": 9735.0, "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": 1311.84, "discounted_cash": 787.1, "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": 1386.51, "discounted_cash": 831.91, "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": 1355.31, "discounted_cash": 813.19, "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": 1341.63, "discounted_cash": 804.98, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "LIGATION DIVISION AND/OR EXCISION OF VARICOSE VEIN CLUSTER 1 LEG 37785", "code_information": [{"code": "37785", "type": "CPT"}, {"code": "2001903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "LIGATION HEMORRHOIDAL VASCULAR BUNDLES INCLUDING ULTRASOUND GUIDANCE 0249T", "code_information": [{"code": "249T", "type": "CPT"}, {"code": "10710866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3058.0, "maximum": 3058.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 BANDING ANGIOACCESS ARTERIOVENOUS FISTULA 37607", "code_information": [{"code": "37607", "type": "CPT"}, {"code": "1839673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1827.1, "maximum": 8450.0, "gross_charge": 3775.0, "discounted_cash": 2265.0, "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": 1827.1, "methodology": "fee schedule"}, {"payer_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 OR BIOPSY TEMPORAL ARTERY 37609", "code_information": [{"code": "37609", "type": "CPT"}, {"code": "2034643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1028.5, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION 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": 590.1, "discounted_cash": 354.06, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATOR MULTI BAND 10 BANDS SHOOTER SAEED", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "G22614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 851.92, "discounted_cash": 511.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT CABLE BATTALION LLIF", "code_information": [{"code": "27436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.5, "discounted_cash": 755.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT MAT DISP", "code_information": [{"code": "LB-133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1603.0, "discounted_cash": 961.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT MAT INTECH DISP", "code_information": [{"code": "6460-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SOURCE 81038-180", "code_information": [{"code": "81038-180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.28, "discounted_cash": 720.77, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SOURCE LOW PROFILE MALLEABLE ILLUMINATOR", "code_information": [{"code": "11-07032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1346.22, "discounted_cash": 807.73, "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 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 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{"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, 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{"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 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"both", "billing_class": "facility"}]}, {"description": "LINER ACET R3 XLPE 20DEG +4 40 X 56MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4008.0, "discounted_cash": 2404.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 32MM X 48MM 0DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71339548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3288.0, "discounted_cash": 1972.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 6.5MM X 45MM G7 SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10001002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 194.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR G7 36MM SZ F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 32MM X 50MM 0DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71339550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3288.0, "discounted_cash": 1972.8, "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": 3288.0, "discounted_cash": 1972.8, "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": 2448.0, "discounted_cash": 1468.8, "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": 1540.0, "discounted_cash": 924.0, "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": 3288.0, "discounted_cash": 1972.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 40MM X 50MM XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6680.0, "discounted_cash": 4008.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 56MM CONSTRAINED R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71339156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9940.0, "discounted_cash": 5964.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER IMPLANT 28MM X 44MM COBALT CHROME SHELL BIPOLAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71322044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3870.0, "discounted_cash": 2322.0, "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": 7230.0, "discounted_cash": 4338.0, "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": 3288.0, "discounted_cash": 1972.8, "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": 1.8, "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"}, 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": "LIQUIBAND RAPID SKIN ADHESIVE WITH WINGED APPLICATOR 0.8 ML M1207", "code_information": [{"code": "M1207", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "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": 9.43, "discounted_cash": 5.66, "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": 5.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 7852.0, "discounted_cash": 4711.2, "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": 6530.0, "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": 6530.0, "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": 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 PPO", "standard_charge_dollar": 9675.0, "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": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3800.36, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 743.0, "discounted_cash": 445.8, "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": 12.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 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", "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": "LMA UNIQUE SILICONE CUFF AIRWAY WITH PILOT BALLOON SIZE 2.5 HUD300000025H", "code_information": [{"code": "HUD300000025H", "type": "CDM"}], "standard_charges": [{"gross_charge": 28.75, "discounted_cash": 17.25, "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": "LOCK PLATE 10 HOLE NARROW 2.7 L79MM 629730", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1992.68, "discounted_cash": 1195.61, "setting": "both", "billing_class": "facility"}]}, {"description": "LOCK SYRINGE STERILE LUER 10ML SYR110010Z", "code_information": [{"code": "SYR110010Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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 VESSEL MINI RED STERION STRL", "code_information": [{"code": "11001PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.45, "discounted_cash": 6.27, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP VESSEL RED SUT MAXI", "code_information": [{"code": "AS3901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.01, "discounted_cash": 9.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP WIRE NUMBER 0 3.5MM 36IN WORKING LEN W/ STRAIGHT NDL TIGERLOOP", "code_information": [{"code": "AR-7258T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.65, "discounted_cash": 48.99, "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": 11.67, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM 1MG TAB", "code_information": [{"code": "MED0740", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOSIS 22MM WIDTH 50MM LENGTH 14MM HEIGHT 8DEG 8722-5014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8722-5014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOSIS TALOS IBF 11X10X28 6\u00c2\u00ba 2-111028-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-111028-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ASSEMBLED CERVICAL 7 MM AC-07L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AC-07L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ASSEMBLED CERVICAL 8 MM AC-08L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AC-08L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.0, "discounted_cash": 2008.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ASSEMBLED CERVICAL 9 MM AC-09L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AC-09L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.0, "discounted_cash": 2008.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE FOUNDATION CERVICAL 5MM CL0705", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CL0705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3800.0, "discounted_cash": 2280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE FOUNDATION CERVICAL 7MM CL0707", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CL0707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE FOUNDATION LARGE CERVICAL 11 MM LCL0711", "code_information": [{"code": "LCL0711", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE FOUNDATION LARGE CERVICAL 12 MM LCL0712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCL0712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "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": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER CORTICAL CANCELLOUS 6MM T 99301-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "99301-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER CORTICAL CANCELLOUS 7MM T 99301-07", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "99301-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER CORTICAL CANCELLOUS 8MM T 99301-08", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "99301-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER CORTICAL CERVICAL 6MM PTT-LCCS-06S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PTT-LCCS-06S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23000.0, "discounted_cash": 13800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER CORTICAL CERVICAL 9MM PTT-LCCS-09S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PTT-LCCS-09S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "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": "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 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{"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 EXT. FACIAL PLANE BLOCK; UNI INCL IMAGING 64473", "code_information": [{"code": "64473", "type": "CPT"}, {"code": "46552728", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "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 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": "LP SCREW 3.0X14MM CORTICAL MTP TI AR-9933-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 271.0, "discounted_cash": 162.6, "setting": "both", "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": "LR 3000ML BAG", "code_information": [{"code": "MED0270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.8, "discounted_cash": 30.48, "setting": "both", "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "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": 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": "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": 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": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "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": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 11473.0, "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": "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": "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": "LUBRICANT JELLY 5GM RELIAMED FOIL", "code_information": [{"code": "ZRLJ33183G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY 120GM TUBE", "code_information": [{"code": "MED0133", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.79, "discounted_cash": 13.07, "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": 4.14, "discounted_cash": 2.48, "setting": "both", "billing_class": "facility"}]}, {"description": "LUGOLS 30ML SOLUTION", "code_information": [{"code": "MED0134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 170.43, "discounted_cash": 102.26, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PEEK INTERBODY 10MM X 27MM X 11MM 5 DEGREE POROUS COATED P11027-511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P11027-511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 2640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PEEK INTERBODY 10MM X 32MM X 12MM 5 DEGREE POROUS COATED P11032-512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P11032-512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 5400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PEEK INTERBODY 12MM X 27MM X 10MM 5 DEGREE 11227-510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11227-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PEEK INTERBODY 12MM X 27MM X 11MM 5 DEGREE 11227-511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11227-511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 2400.0, "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", "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": 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": 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": 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": 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": 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": 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": 1301.0, "methodology": "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "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": 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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_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": 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", "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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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": 0.51, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"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", "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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "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"}], "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": 1584.09, "discounted_cash": 950.45, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.44, "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": 469.0, "discounted_cash": 281.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LYNC DISTAL RASP XRA01002", "code_information": [{"code": "XRA01002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 716.55, "discounted_cash": 429.93, "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": 1800.0, "discounted_cash": 1080.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.54, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": "M3 STAND ALONE ALIF CAGE 25MM X 35MM 15 DEG 14MM 3AS2535-1514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 10.99, "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": "MAESTRO LONG CANN DRILL BIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "409473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 861.47, "discounted_cash": 516.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CAPITATE STEM 6X18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3290.0, "discounted_cash": 1974.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL HD 7X15MM STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3290.0, "discounted_cash": 1974.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X37 6 AUG", "code_information": [{"code": "180303", "type": "CDM"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X43 14 AUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3290.0, "discounted_cash": 1974.0, "setting": "both", "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": "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": 1952.0, "methodology": "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": 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": 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": "MAGNEVIST INJ SOL 5 ML", "code_information": [{"code": "MED0136", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 64.3, "discounted_cash": 38.58, "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 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"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": 55496.26, "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, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "MALE POST 2 HOLE RR20P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RR20P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.2, "discounted_cash": 150.12, "setting": "both", "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, "estimated_discounted_cash": 6098.0, "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": "MANIFOLD CARTRIDGE 11G VERTEPORT X4", "code_information": [{"code": "605-411-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 851.18, "discounted_cash": 510.71, "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": 1026.89, "discounted_cash": 616.13, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 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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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.93, "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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 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"plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 11.47, "discounted_cash": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MARGIN MAP SPECIMEN ORIENTATION CHARMS 308", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2290.0, "discounted_cash": 1374.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER PEDICLE 5.5MM LFT ZODIAC", "code_information": [{"code": "62911-L55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER PINPOINT MULTI-MODALITY FIDUCIAL CT/MRI IMAGE REGISTRATION", "code_information": [{"code": "128", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.87, "discounted_cash": 10.12, "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": 4.39, "discounted_cash": 2.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SPOT 5CC ENDOSCOPY", "code_information": [{"code": "GIS-44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.3, "discounted_cash": 55.38, "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": 3.44, "discounted_cash": 2.06, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER TISSUE BIOZORB 3 X 3CM", "code_information": [{"code": "A4648", "type": "HCPCS"}, {"code": "F0303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 1140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER TISSUE BIOZORB 3 X 4CM", "code_information": [{"code": "A4648", "type": "HCPCS"}, {"code": "F0304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 1140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKERS MINI TRADITIONAL INK MARKER NON-STERILE VIS14511000Z", "code_information": [{"code": "VIS14511000Z", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKERS NAVIO FLAT PFSDV0016", "code_information": [{"code": "PFSDV0016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1251.86, "discounted_cash": 751.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKERSTERILE REGULAR TIP DYNJSM07 DYNJSM07", "code_information": [{"code": "DYNJSM07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER 47300", "code_information": [{"code": "47300", "type": "CPT"}, {"code": "44623924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.33, "maximum": 8450.0, "gross_charge": 6201.0, "discounted_cash": 3720.6, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3001.28, "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": 2046.33, "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": "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": 9.62, "discounted_cash": 5.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA ADULT LARGE SIZE 6", "code_information": [{"code": "DYNJAAMASK6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.16, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA CHILD SZ 4 LG PREMIUM LF PEDI", "code_information": [{"code": "DYNJAAMASK4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.44, "discounted_cash": 4.46, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SM SZ 2 PREMIUM LF INFANT", "code_information": [{"code": "DYNJAAMASK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.12, "discounted_cash": 4.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SM SZ 3 PREMIUM LF PEDI", "code_information": [{"code": "DYNJAAMASK3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.12, "discounted_cash": 4.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 5 PREMIUM LF ADLT", "code_information": [{"code": "DYNJAAMASK5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.46, "discounted_cash": 5.08, "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": 6.34, "discounted_cash": 3.8, "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": 1.8, "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": 3.13, "discounted_cash": 1.88, "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": 6.9, "discounted_cash": 4.14, "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": 1.8, "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": 6.21, "discounted_cash": 3.73, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE REG SURG STRL ADLT DISP", "code_information": [{"code": "7210559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.82, "discounted_cash": 47.29, "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": 6.96, "discounted_cash": 4.18, "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": 26.16, "discounted_cash": 15.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 5 MEDINFLATABLE LF ADLT", "code_information": [{"code": "1055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.01, "discounted_cash": 3.61, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SILICONE REUSABLE", "code_information": [{"code": "DYND280025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.17, "discounted_cash": 159.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SUP AIRWAY STERILE SZ 3 ALBF030SU", "code_information": [{"code": "ALBF030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.83, "discounted_cash": 29.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SUP AIRWAY STERILE SZ 4 ALBF040SU", "code_information": [{"code": "ALBF040SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.83, "discounted_cash": 29.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SUP AIRWAY STRL SZ 5 ALBF050SU", "code_information": [{"code": "ALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.83, "discounted_cash": 29.3, "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": 32.6, "discounted_cash": 19.56, "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": 31.21, "discounted_cash": 18.73, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SUPREME SZ 5 HUDALBF050SU", "code_information": [{"code": "HUDALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.24, "discounted_cash": 28.34, "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": 4.77, "discounted_cash": 2.86, "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": 4.05, "discounted_cash": 2.43, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN ELONGATED ADULT HUD1930", "code_information": [{"code": "HUD1930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 3.11, "discounted_cash": 1.87, "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": 1.8, "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": 1.8, "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": 4.43, "discounted_cash": 2.66, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN NON-REBREATHER PEDIATRIC", "code_information": [{"code": "1058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.34, "discounted_cash": 3.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN PANORAMIC ADULT 301-0318LT", "code_information": [{"code": "301-0318LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.47, "discounted_cash": 44.68, "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": 1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK REGISTRATION AUTO FORINTELLECT CRANIAL SYSINTELLECT", "code_information": [{"code": "6001-386-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 861.79, "discounted_cash": 517.07, "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": 3.34, "discounted_cash": 2.0, "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": 34.38, "discounted_cash": 20.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SM ADULT UNSCENTED KNG1045", "code_information": [{"code": "KNG1045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.33, "discounted_cash": 3.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SURG SPECIALTY PLEATED SPLASH RESISTANT SENSITIVE SKIN W/ TIES", "code_information": [{"code": "1072835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.23, "discounted_cash": 24.14, "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": 1.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "MASTECTOMY", "code_information": [{"code": "19162", "type": "CPT"}, {"code": "1481285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 3937.0, "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 MODIFIED RADICAL 19307", "code_information": [{"code": "19307", "type": "CPT"}, {"code": "1481286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "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": "MASTECTOMY PARTIAL 19301", "code_information": [{"code": "19301", "type": "CPT"}, {"code": "1481287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "MASTECTOMY PARTIAL W/AXILLARY LYNPHADENECTOMY 19302", "code_information": [{"code": "19302", "type": "CPT"}, {"code": "1481292", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2019.24, "maximum": 9357.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "MASTECTOMY RADICAL W/AXILLARY LYMPH NODES 19305", "code_information": [{"code": "19305", "type": "CPT"}, {"code": "1481288", 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"standard_charges": [{"gross_charge": 71.28, "discounted_cash": 42.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-CUFF TOURNIQUET STERILE W/PLC 24\" 60707010400", "code_information": [{"code": "60707010400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "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": 533.83, "discounted_cash": 320.3, "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": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ELECTRODE ADULT POLYHESIVE PAT 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"both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE SURGCL ORTHO SYNTH ESTEEM PF 6", "code_information": [{"code": "2D73ET60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.46, "discounted_cash": 2.68, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE SURGCL ORTHOSYNTH ESTEEM PF6.5", "code_information": [{"code": "2D73ET65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.88, "discounted_cash": 4.73, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE SURGCLORTHO SYNTH ESTEEM PF 9", "code_information": [{"code": "2D73ET90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.46, "discounted_cash": 2.68, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE SURGICAL ORTHO SYNTH ESTM PF 7", "code_information": [{"code": "2D73ET70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.46, "discounted_cash": 2.68, "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": 7.77, "discounted_cash": 4.66, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-KIT CATHETER RADIAL 20GA 4FR AK-04020-C", "code_information": [{"code": "AK-04020-C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.75, "discounted_cash": 53.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-NEEDLE 18GX3\" PINK HUB STRL SINGLE U 405174", "code_information": [{"code": "405174", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.81, "discounted_cash": 3.49, "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": 6.38, "discounted_cash": 3.83, "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": 173.36, "discounted_cash": 104.02, "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": 228.24, "discounted_cash": 136.94, "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": 103.84, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET INFSOMT LUER 15 DP/ML 120IN 22ML 490100", "code_information": [{"code": "490100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.5, "discounted_cash": 17.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET PMP 15 DROP UNIV SPIKE 2 CRESITE", "code_information": [{"code": "490102", "type": "CDM"}], "standard_charges": [{"gross_charge": 469.37, "discounted_cash": 281.62, "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": 11.85, "discounted_cash": 7.11, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SODCHLORDE IRRIG0.9% 1000ML 2B7124X", "code_information": [{"code": "2B7124X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.41, "discounted_cash": 12.25, "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": 10.58, "discounted_cash": 6.35, "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": 36.09, "discounted_cash": 21.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER ECHELON FLEX POWERED ENDO PLEE60A", "code_information": [{"code": "PLEE60A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 940.79, "discounted_cash": 564.47, "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": 35.33, "discounted_cash": 21.2, "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": 33.54, "discounted_cash": 20.12, "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": 81.05, "discounted_cash": 48.63, "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": 25.77, "discounted_cash": 15.46, "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": 814.45, "discounted_cash": 488.67, "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": 472.36, "discounted_cash": 283.42, "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": 228.24, "discounted_cash": 136.94, "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": 52.44, "discounted_cash": 31.46, "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": 6.79, "discounted_cash": 4.07, "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": 13.29, "discounted_cash": 7.97, "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": 57.7, "discounted_cash": 34.62, "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": 175.41, "discounted_cash": 105.25, "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": 7.75, "discounted_cash": 4.65, "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": 11.42, "discounted_cash": 6.85, "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": 329.49, "discounted_cash": 197.69, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-TOURNIQUET DISPOSABLE 24 5921-024-135", "code_information": [{"code": "5921-024-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.78, "discounted_cash": 37.67, "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": 329.49, "discounted_cash": 197.69, "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", 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found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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, 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 POST VOIDING RESIDUAL URINE/BLADDER BY ULTRASOUND NON IMAGE 51798", "code_information": [{"code": "51798", "type": "CPT"}, {"code": "1643977", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 908.0, "discounted_cash": 544.8, "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": 439.47, "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": "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "standard_charge_dollar": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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"plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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-VAC SUCTION TUBING BXTN612", "code_information": [{"code": "BXTN612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.37, "discounted_cash": 2.62, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDI-VAC YANKAUER STERILE SUCTION HANDLES BXTK86", "code_information": [{"code": "BXTK86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 32668.6, "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 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SMALL BORE IV EXTENSION SET DYNDTC5081", "code_information": [{"code": "DYNDTC5081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "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 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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"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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 33.55, "discounted_cash": 20.13, "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": 20.19, "discounted_cash": 12.11, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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DRILL BIT 3MM X 60MM", "code_information": [{"code": "57S00030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.92, "discounted_cash": 391.15, "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": 1430.0, "discounted_cash": 858.0, "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": 1034.08, "discounted_cash": 620.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRO DRILL AT3 80-4139", "code_information": [{"code": "80-4139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1593.84, "discounted_cash": 956.3, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.93, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.14, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": "MICROCUVETTES HEMOCHROMA PLUS 100-202", "code_information": [{"code": "100-202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.44, "discounted_cash": 6.26, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.38, "methodology": "fee schedule"}], "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": 71.32, "discounted_cash": 42.79, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROMATRIX 200 MG MM0200", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "MM0200", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "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": 1.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 1322.0, "discounted_cash": 793.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "MIDAZOLAM 2MG/2ML INJECTION PF VIAL", "code_information": [{"code": "MED0238", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDAZOLAM 5MG/5ML VIAL", "code_information": [{"code": "MED0437", "type": 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"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", 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3206.0, "discounted_cash": 1923.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MINERAL OIL 100% 10ML", "code_information": [{"code": "MED0145", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.88, "discounted_cash": 36.53, "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": 491.75, "discounted_cash": 295.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MINIGRIPALLIGATOR GRASPER PERCERTANEOUS SURGICAL", "code_information": [{"code": "PGAC300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 625.23, "discounted_cash": 375.14, "setting": "both", "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": 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"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": 181.08, "discounted_cash": 108.65, "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": 55.81, "discounted_cash": 33.49, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": "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": 1956.0, "discounted_cash": 1173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXING AND DELIVERY SYSTEM BONE CEMENT", "code_information": [{"code": "414702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.92, "discounted_cash": 191.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXING AND INJECTION DEVICE", "code_information": [{"code": "VCF-1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"1233829", "type": "CDM"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 363.0, "discounted_cash": 217.8, "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 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", "standard_charge_dollar": 134.81, "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": "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 DP RX DLVR DEV", "code_information": [{"code": "20700", "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": "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "MOBI-C CERVICAL DISC 13X15 H7 US MB3357", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56000.0, "discounted_cash": 33600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOBI-C CERVICAL DISC 15X19 H6 US MB3596", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 70000.0, "discounted_cash": 42000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOBI-C CERVICAL DISC 17MM X 17MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50000.0, "discounted_cash": 30000.0, "setting": "both", "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": "MODULE JET-X EX-FIX CENTRAL BODY COMPRESSION DISTRACTION LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71051053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1471.8, "discounted_cash": 883.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULE MONITORING EMG NVM5", "code_information": [{"code": "8050215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3930.56, "discounted_cash": 2358.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULE NDL M5 EMG", "code_information": [{"code": "8050015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3220.0, "discounted_cash": 1932.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "MONITOR CARBON DIOXIDE END TIDAL EASYCAP ADLT", "code_information": [{"code": "EASYCAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.53, "discounted_cash": 28.52, "setting": "both", "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": 180.53, "discounted_cash": 108.32, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.33, "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": 140.5, "discounted_cash": 84.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MONOVISC 22MG/ML 4ML SYRINGE (MEDID)", "code_information": [{"code": "MED0626", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3058.0, "discounted_cash": 1834.8, "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": 10.3, "discounted_cash": 6.18, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.95, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.34, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 231.5, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "MORPHINE PF/DURAMORPH 10MG/10ML", "code_information": [{"code": "MED0149", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.81, "discounted_cash": 29.29, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE/DURAMORPH 5MG/10ML", "code_information": [{"code": "MED0150", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 51.3, "discounted_cash": 30.78, "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": "MOTOBAND POLYAXIAL LOCKING SCREW 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 216.0, "setting": "both", "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": 3590.0, "discounted_cash": 2154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOCLIP HIMAX 18X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7118-1818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 1560.0, "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": "MOUTH SILICONE BITE OM116R OM118R OM119R MA307R OM170", "code_information": [{"code": "OM170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.72, "discounted_cash": 11.83, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.53, "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": 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", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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 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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for 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"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", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "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": 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": 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": 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 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 1952.0, "methodology": "fee 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{"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": 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", 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"standard_charge_dollar": 2261.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1658.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 1352.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1980.3, "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, 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"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", "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": 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": 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": 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"methodology": "percent of 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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", 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"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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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"AETNA", "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": "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": 1952.0, "methodology": "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": 4620.0, "methodology": "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", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 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"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", 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1743.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": 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": "MS PANEL", "code_information": [{"code": "83916", "type": "CPT"}, {"code": "1233831", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 256.0, "discounted_cash": 153.6, "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": 34.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 95.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.84, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", 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"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", 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 166.62, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 50.94, "discounted_cash": 30.56, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.28, "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": 25.68, "discounted_cash": 15.41, "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": 70.45, "discounted_cash": 42.27, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 115.43, "discounted_cash": 69.26, "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/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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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"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, "estimated_discounted_cash": 33600.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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, 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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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_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": 1952.0, "methodology": "fee schedule"}, {"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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": 1952.0, "methodology": "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": 0.51, "methodology": "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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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", "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": 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": 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 ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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469.0, "discounted_cash": 281.4, "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": 3.0, "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": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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/SPHENOIDOTOMY 31287", "code_information": [{"code": "31287", "type": "CPT"}, {"code": "1635700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 1027.53, "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/DILATION OF FRONTAL/SPHENOID SINUS OSTIA 31298", "code_information": [{"code": "31298", "type": "CPT"}, {"code": "44896135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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"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": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 TUOHY EPID 18GX3.5\" PLASTIC STYLET", "code_information": [{"code": "PAIN8005.", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.33, "discounted_cash": 14.6, "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": 11.85, "discounted_cash": 7.11, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 DCMPRN 1 NTRSPC LUMBAR", "code_information": [{"code": "62380", "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4.08, "discounted_cash": 2.45, "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": 3.22, "discounted_cash": 1.93, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11GA JAMSHIDI", "code_information": [{"code": "LS-277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 337.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11GA RAN-1115N5T-BEV", "code_information": [{"code": "RAN-1115N5T-BEV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11GX6 BONEMARROW JAMSHIDI BI TJC6011", "code_information": [{"code": "TJC6011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.75, "discounted_cash": 50.25, "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": 84.63, "discounted_cash": 50.78, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18GX6 PINK HUB STRL SINGLE USE 408360", "code_information": [{"code": "408360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.46, "discounted_cash": 14.08, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18GX6 PINK TUOHY EPIDURAL 25 C", "code_information": [{"code": "183A021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.36, "discounted_cash": 15.22, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20G X 6IN STIMUPLEX ULTRA 360 ECHOGENIC", "code_information": [{"code": "333646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.17, "discounted_cash": 43.3, "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": 5.84, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX3.5 SPINAL STERILE PENCAN 333866", "code_information": [{"code": "333866", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.38, "discounted_cash": 17.63, "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": 28.75, "discounted_cash": 17.25, "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": 23.46, "discounted_cash": 14.08, "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": 12.19, "discounted_cash": 7.31, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 36MM RECSE CUTTING 1/2 CIRCLE W/LOOP AR-7280", "code_information": [{"code": "AR-7280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.75, "discounted_cash": 463.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 6IN COUDE EPIDURAL", "code_information": [{"code": "105-1613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.8, "discounted_cash": 303.48, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 6IN COUNTOUR NERVE BLOCK TOUGHEY", "code_information": [{"code": "PL18150TGC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.1, "discounted_cash": 89.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 6IN TUOHY", "code_information": [{"code": "M00532-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.75, "discounted_cash": 130.65, "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": 609.21, "discounted_cash": 365.53, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS 11GA X 15 CM HARVEST", "code_information": [{"code": "RAN-1115", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "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": 103.71, "discounted_cash": 62.23, "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": 92.85, "discounted_cash": 55.71, "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": 10.12, "discounted_cash": 6.07, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ARTHROSCOPY 17GA 19IN EXTRA LONGINSTR", "code_information": [{"code": "72201811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.53, "discounted_cash": 144.32, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ARTHROSCOPYINSTR", "code_information": [{"code": "7209350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.1, "discounted_cash": 132.66, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION 11G X 10CM", "code_information": [{"code": "BMN20", "type": "CDM"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 367.2, "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": 876.72, "discounted_cash": 526.03, "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": 744.65, "discounted_cash": 446.79, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 15G BONE MARROW", "code_information": [{"code": "SPP99BM15A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.5, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY ASPIRATE BONE MARROW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "97000501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 2160.0, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 CYPHER", "code_information": [{"code": "14-501659", "type": "CDM"}], "standard_charges": [{"gross_charge": 772.75, "discounted_cash": 463.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY TRU-CUT 20MM SPECIMEN NOTCH SCALPEL SHARP SURG STEEL CUTTING EDGE", "code_information": [{"code": "2N2704X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.58, "discounted_cash": 59.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLOCK 18GA 50MM X 2IN TUOHY BEVELINSTR", "code_information": [{"code": "PL18050TGC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.5, "discounted_cash": 63.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA 11GA 9CM MARROW CELLUTION", "code_information": [{"code": "74219-06M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3423.55, "discounted_cash": 2054.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION", "code_information": [{"code": "C1830", "type": "HCPCS"}, {"code": "74266-01M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2003.75, "discounted_cash": 1202.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION 11G 11CM", "code_information": [{"code": "2604-90020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION 11G 15CM", "code_information": [{"code": "2604-90021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 701.62, "discounted_cash": 420.97, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION 74295-01M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74295-01M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION 8 GAUGE X 15CM", "code_information": [{"code": "74174-01M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION MC-RAN-11C", "code_information": [{"code": "MC-RAN-11C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5610.5, "discounted_cash": 3366.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BREAST 20GA X 10CM HAWKINS II LOCALIZATION REPOSITIONABLE HARDWIRE", "code_information": [{"code": "242100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.04, "discounted_cash": 52.82, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BX 18GA X 6CM QUICK-CORE COAXIAL 10MM THROW SET", "code_information": [{"code": "G28283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.5, "discounted_cash": 186.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CERCLAGE PASSING SINGLE USE", "code_information": [{"code": "AR-7816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.98, "discounted_cash": 206.99, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CHIBA 22GA X 6IN", "code_information": [{"code": "18373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.22, "discounted_cash": 32.53, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ECHOGENIC 20GA X 4IN STIMUPLEX ULTRA", "code_information": [{"code": "333648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.7, "discounted_cash": 49.02, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ECHOLONG 18GA X 50MM TUOHY BEVEL STIMULATING", "code_information": [{"code": "ell18050tgc", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.58, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ECLIPSE 23X1 RB 100/BX 305826", "code_information": [{"code": "305826", "type": "CDM"}, 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{"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", 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"methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "NERVE GRAFT MULTIPLE STRANDS 64902", "code_information": [{"code": "64902", "type": "CPT"}, {"code": "1481336", "type": "CDM"}, 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"standard_charge_dollar": 2204.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2019.24, "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": 9357.0, "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": 4172.0, "discounted_cash": 2503.2, "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", 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 9357.0, "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": 4172.0, "discounted_cash": 2503.2, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"code_information": [{"code": "64893", "type": "CPT"}, {"code": "1481342", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 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{"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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"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 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"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 PROBE ALPHATEC SPINE", "code_information": [{"code": "RL8TP201-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1717.5, "discounted_cash": 1030.5, "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": 4172.0, "discounted_cash": 2503.2, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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 NERVE ALLOGRAFT; EACH ADDITIONAL STRAND 64913", "code_information": [{"code": "64913", "type": "CPT"}, {"code": "45660700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2369.0, "discounted_cash": 1421.4, "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": 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": 1146.59, "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": "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": 3775.0, "discounted_cash": 2265.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1827.1, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"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": "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", "code_information": [{"code": "28055", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"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 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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 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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, 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"maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": "NEVOS FLEX 50MM", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "BNEF5000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 1380.0, "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": "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": 1983.6, "discounted_cash": 1190.16, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": "NG TUBE 16FR W PREVENT FILTER 0046160", "code_information": [{"code": "46160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.44, "discounted_cash": 9.86, "setting": "both", "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "NITINOL STAPLE SYSTEM 15X15X15MM STRAIGHT STAPLE KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P71-015-1515-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3373.5, "discounted_cash": 2024.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL STAPLE SYSTEM 20X20X20MM STRAIGHT STAPLE KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P71-020-2020-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3632.0, "discounted_cash": 2179.2, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee 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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": "NITROGLYCERIN 20 MG/100 ML-D5W IV SOL 250 ML IM", "code_information": [{"code": "1A0694", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 19.26, "discounted_cash": 11.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRVTG SI JT", "code_information": [{"code": "64451", "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": 2827.0, "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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 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", "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 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": 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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "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": 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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "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 CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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 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 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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", 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 - INSULATED BIPOLAR 8 1/2", "code_information": [{"code": "20-1410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "both", "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-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": 8572.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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-E1 POLY HIP CAP PRICE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BTHI-POLY", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 8100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-E1 REG HIP CAP PRICE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BTHI-REG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 8100.0, "setting": "both", "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": 1952.0, "methodology": "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": 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": 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": 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-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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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{"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 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{"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": 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"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", 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"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 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": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "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": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.68, "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": "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": 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": 4620.0, "methodology": "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", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.23, "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": 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": 1301.0, "methodology": "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 1952.0, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 9748.0, "discounted_cash": 5848.8, "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": 1301.0, "methodology": "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": 0.51, "methodology": "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": 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": "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": 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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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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"}]}, 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20.16, "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": 7000.0, "discounted_cash": 4200.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, 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"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, 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"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": 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"plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 1379.88, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1379.88, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.29, "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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.48, "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": "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": 28.3, "discounted_cash": 16.98, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 8312.0, "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": 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": 9357.0, "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": 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": "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", 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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", 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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"standard_charge_percentage": 37.14, "count": "0", "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": 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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 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"plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 636.09, "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": 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": 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "ONDANSETRON 4MG/2ML", "code_information": [{"code": "MED0323", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "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": 2290.0, "discounted_cash": 1374.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 6202.0, "discounted_cash": 3721.2, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"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": 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"standard_charge_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": 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"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": 1519.76, "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": 9735.0, "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 2723.95, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 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": 2723.95, "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", 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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": 1379.88, "maximum": 9735.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 1379.88, "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": "61312", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61315", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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"}], 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 4620.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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": 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": 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": 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": 4620.0, "methodology": "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": 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "OPN IMPLTJ NEA NEUROMUSCULAR", "code_information": [{"code": "64580", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 IMPLTJ NEA SACRAL NERVE", "code_information": [{"code": "64581", "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 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historical data found for payer/plan and coding 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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "UHC", "standard_charge_dollar": 9357.0, "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 ZYGOMATIC ARCH", "code_information": [{"code": "21356", "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 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"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": "UHC", "standard_charge_dollar": 9357.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 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": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "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": "UHC", "standard_charge_dollar": 9357.0, "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 PERIORBITAL", "code_information": [{"code": "21386", "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": "UHC", "standard_charge_dollar": 9357.0, "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": 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": 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 SUPERFICIALIS TENDON TRANSFER TYPE EA. TENDON 26490", "code_information": [{"code": "26490", "type": "CPT"}, {"code": "16222629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4321.0, "discounted_cash": 2592.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2091.36, "methodology": "fee schedule"}, {"payer_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": 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"standard_charge_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": 1519.76, "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": 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[{"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 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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": "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": "OPTIMA ZS 7 X 1.0MM CONNECTOR SH0060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SH0060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTIMA ZS LAMINA HOOK - W5 X 9MM SH0509-A2", "code_information": [{"code": "SH0509-A2", "type": "CDM"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTIMA ZS SMALL DOMINO CONNECTOR SH0040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SH0040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": "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 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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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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 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"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": 2019.24, "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, 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.5, "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": 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": 5628.0, "discounted_cash": 3376.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, 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"standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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": "ORIF TARSAL BONE DISLOCATION 28555", "code_information": [{"code": "28555", "type": "CPT"}, {"code": "2858367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": "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": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee 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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": 207.69, "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": 141.6, "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": "OSTEOPLASTY LENGTENING METACARPAL OR PHALANX 26568", "code_information": [{"code": "26568", "type": "CPT"}, {"code": "1481481", "type": "CDM"}, {"code": "360", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 5628.0, "discounted_cash": 3376.8, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": 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"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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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"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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME 7MM SQUARE SN24", "code_information": [{"code": "SN24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, 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"methodology": "fee schedule"}, {"payer_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 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": 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": "OT Ultrasound Charges", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "1017869", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 37.51, "maximum": 8450.0, "gross_charge": 101.0, "discounted_cash": 60.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 41.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 41.46, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 51.13, "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": 37.51, "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": "OT Wheelchair Management Charge", "code_information": [{"code": "97542", "type": "CPT"}, {"code": "1646834", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 86.9, "maximum": 8450.0, "gross_charge": 234.0, "discounted_cash": 140.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 96.05, "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": 96.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 118.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 86.9, "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": 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": "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 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, "estimated_discounted_cash": 21907.7, "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, "estimated_discounted_cash": 11925.12, "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, "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, "estimated_discounted_cash": 9658.0, "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": 8274.29, "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, "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": 16629.51, "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": 6535.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.51, "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": 58.98, "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, "estimated_discounted_cash": 784.0, "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": 32025.43, "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": 32874.79, "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, "estimated_discounted_cash": 6658.16, "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 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, 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8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVARIAN CYSTECTOMY 58925", "code_information": [{"code": "58925", "type": "CPT"}, {"code": "1481526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 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{"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 +8 71342208", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71342208", "type": "CDM"}, {"code": "278", 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"code_information": [{"code": "MED0009", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.13, "discounted_cash": 18.68, "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": 11.17, "discounted_cash": 6.7, "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", 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"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 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{"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": "Occult Blood Gastric Fluid", "code_information": [{"code": "82271", "type": "CPT"}, {"code": "633787", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 81.0, "discounted_cash": 48.6, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}, {"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": "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", 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{"description": "PADDING UNDERCAST 6IN X 4YD SOFT POUCH COTTON WEBRIL STRL", "code_information": [{"code": "2554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.23, "discounted_cash": 7.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING UNDERCAST WYTEX 2IN X 4YD STERILE", "code_information": [{"code": "DYNJ066002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.76, "discounted_cash": 4.66, "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": 16.39, "discounted_cash": 9.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDLE LEAD 45CM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3000-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 6000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDLE PNEUMATIC COMPRESSION", "code_information": [{"code": "292131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.25, "discounted_cash": 547.95, "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": 457.75, "discounted_cash": 274.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PADS PTP BOLSTER 138-6000", "code_information": [{"code": "138-6000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1603.0, "discounted_cash": 961.8, "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 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"methodology": "fee schedule"}, {"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": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "PALMAR FASCIETOMY PALM PARTIAL 26123", "code_information": [{"code": "26123", "type": "CPT"}, {"code": "1481528", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "PALMAR FASCIOTOMY 26040", "code_information": [{"code": "26040", "type": "CPT"}, {"code": "1481529", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 2989.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": "PAPER 50 MM X 25.6 M (2 IN X 84 FT) BLANK THERMAL 2106824-001", "code_information": [{"code": "2106824-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.85, "discounted_cash": 7.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER FOR MINDRAY DATASCOPE TRIO PATIENT MONITORS MND300050502", "code_information": [{"code": "MND300050502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.2, "discounted_cash": 10.92, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 2123.0, "discounted_cash": 1273.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PARADERM 4 X 4 DERMAL MATRIX", "code_information": [{"code": "PDMW-4X4", "type": "CDM"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "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", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.54, "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": 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": 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": 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": 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", "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": 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": 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 AUTOTRANSPLANTATION 60512", "code_information": [{"code": "60512", "type": "CPT"}, {"code": "7616963", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 2279.15, "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": "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": 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": 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": 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": 2279.15, "maximum": 9357.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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": 2279.15, "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": "PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID RE-EXPLORATION 60502", "code_information": [{"code": "60502", "type": "CPT"}, {"code": "28958153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2192.03, "maximum": 9357.0, "gross_charge": 4529.0, "discounted_cash": 2717.4, "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": 2192.03, "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": "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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "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": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "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": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", 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"standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], 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"standard_charge_dollar": 9735.0, "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 BONE CLAVICLE 23180", "code_information": [{"code": "23180", "type": "CPT"}, {"code": "1481550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": 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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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee 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"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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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"methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3527.0, "methodology": 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"plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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", 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"RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 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": 9735.0, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "44140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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 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"AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"UHC", "standard_charge_dollar": 5892.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 4620.0, "methodology": "fee 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "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": "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", 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{"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": 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": 8450.0, "methodology": "fee 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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 REPORT NOT SENT", "code_information": [{"code": "G9786", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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", 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{"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": 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4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 540.0, "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 PROGRAMMER NEUROSTIMULATOR ST JUDE", "code_information": [{"code": "3853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2986.16, "discounted_cash": 1791.7, "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": 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"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": 569.28, "discounted_cash": 341.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT TRACKER NON-INVASIVE", "code_information": [{"code": "9734887XOM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.89, "discounted_cash": 284.93, "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": 4.62, "discounted_cash": 2.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PATTY SURG 3IN X 1/2IN STRIP ONE STRING XRAY DETECT 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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"plan_name": "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 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"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": "PEDI RED DOT MONITORING ELECRTODE", "code_information": [{"code": "2268-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "discounted_cash": 2.76, "setting": "both", "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": "PEEK 10 X 20MM IF SCRW NON-VENTED AR-4020P-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4020P-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 383.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF MEDIUM 12 DEGREE 12MM A1112", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "A1112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF MEDIUM 12 DEGREE 14MM A1114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A1114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF MEDIUM 12 DEGREE 18MM A1118", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A1118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF MEDIUM 6 DEGREE 12MM A1012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A1012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF MEDIUM 6 DEGREE 14MM A1014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A1014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK ALIF SMALL 12 DEGREE 14MM A3114", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "A3114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CAGE W14D14H8 PE141408", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PE141408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40000.0, "discounted_cash": 24000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL MEDIUM 6 DEGREE 6MM C3006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C3006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL MEDIUM 6 DEGREE 7MM C3007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C3007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL MEDIUM 6 DEGREE 8MM C3008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C3008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL MEDIUM 6 DEGREE 9MM C3009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C3009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "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": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL SMALL 6 DEGREE 7MM C4007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C4007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL SMALL 6 DEGREE 8MM C4008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C4008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6690.0, "discounted_cash": 4014.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK FAST THREAD 7 X 20MM P AR-4020P-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4020P-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 383.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK LUMBAR CAGE L22 A4 H11 PLA1411", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PLA1411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30000.0, "discounted_cash": 18000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK LUMBAR CAGE L26 A4 H11 PLA2411", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLA2411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49940.0, "discounted_cash": 29964.0, "setting": "both", "billing_class": 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{"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": 218.0, "discounted_cash": 130.8, "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": 174.0, "discounted_cash": 104.4, "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": 174.0, "discounted_cash": 104.4, "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": 174.0, "discounted_cash": 104.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 4.0 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STPT20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.58, "discounted_cash": 101.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 4.0 X 52.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STPT525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.58, "discounted_cash": 101.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 4.0MM X 47.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "STPT475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.58, "discounted_cash": 101.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREAED 4.0MM X 37.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "STPT375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.58, "discounted_cash": 101.75, "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": "57410", "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": "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 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 FIXATION OTHER THAN SACRUM 22848", "code_information": [{"code": "22848", "type": "CPT"}, {"code": "22140355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 211.5, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 262.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 211.5, "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": "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": "PENCIL CAUTERY HOLSTER ELECTROSURGICAL LFINSTR DISP", "code_information": [{"code": "E2516H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.92, "discounted_cash": 31.15, "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": 38.73, "discounted_cash": 23.24, "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": 49.72, "discounted_cash": 29.83, "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": 38.73, "discounted_cash": 23.24, "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": 29.55, "discounted_cash": 17.73, "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": 49.19, "discounted_cash": 29.51, "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": 23.4, "discounted_cash": 14.04, "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": 65.33, "discounted_cash": 39.2, "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": 15.01, "discounted_cash": 9.01, "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": 91.86, "discounted_cash": 55.12, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1163.32, "discounted_cash": 697.99, "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": 9735.0, "gross_charge": 13255.0, "discounted_cash": 7953.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6415.42, "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": "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": 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": 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 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{"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": 46.98, "discounted_cash": 28.19, "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", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "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": 1519.76, "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": "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 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"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": "PERISTRIP 60MM PSD6006-ECH-V", "code_information": [{"code": "PSD6006-ECH-V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.21, "discounted_cash": 264.13, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "PERMANENT REINFORCED BIOSCAFFOLD OVITEX 10CM X 12CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "F10244-1012P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 1368.0, "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": 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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": "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": 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": 9357.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "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": 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": 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3596.0, "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "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": 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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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": "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": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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 PPO", "standard_charge_dollar": 8450.0, "methodology": "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 WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "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": 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 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": "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": 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": 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 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", "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 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": 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": 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": 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": 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 PPO", "standard_charge_dollar": 8896.0, "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": 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": 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": 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 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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", "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": 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", "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": 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", "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", "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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_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": 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": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": 1952.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_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": 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": "PETRI DISH 100 X 15MM 17240/48", "code_information": [{"code": "17240/48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.49, "discounted_cash": 5.69, "setting": "both", "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": "PHALANGECTOMY TOE 28150", "code_information": [{"code": "28150", "type": "CPT"}, {"code": "1481599", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "PHALINX ANGLED MED", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2386.0, "discounted_cash": 1431.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM XL K WIRE BLUNT 1.5MM X 350MM 14 ML-0301", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ML-0301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 360.0, "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": "PHARYNGOPLASTY 42950", "code_information": [{"code": "42950", "type": "CPT"}, {"code": "1836677", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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, 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{"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, 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1246.08, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 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historical data found for payer/plan and coding combination", "standard_charge_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": "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 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"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 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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 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"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": 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", 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 388.6, "discounted_cash": 233.16, "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": 338.35, "discounted_cash": 203.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PICO 7 1 DRESSING 10 X 40CM 66022014", "code_information": [{"code": "66022014", "type": "CDM"}], "standard_charges": [{"gross_charge": 772.75, "discounted_cash": 463.65, "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": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": "PILL SPLITTER NON135000", "code_information": [{"code": "NON135000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.82, "discounted_cash": 4.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW ABDUCTION MED FOAM DEVONO LF", "code_information": [{"code": "31143061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.08, "discounted_cash": 49.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW FILLED 18IN X 24IN TAN 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"discounted_cash": 48.83, "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": 65.91, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW REUSABLE 20IN X 26IN TAN FLUID RESISTANT POLYESTER FILLED NYLEX II", "code_information": [{"code": "MDT219715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.62, "discounted_cash": 12.97, "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": 241.74, "discounted_cash": 145.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOT HOLE CREATOR PC-200", 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"facility"}]}, {"description": "PIN 2.0MM MEMO FIX", "code_information": [{"code": "MS-2650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.75, "discounted_cash": 463.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.0MM X 9 THREADED TIP CANNULATED 5.0MM", "code_information": [{"code": "OS323023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "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": 562.0, "discounted_cash": 337.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.7MM MEMOFIX", "code_information": [{"code": "MS2660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 423.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 22MM BIORESORBABLE", "code_information": [{"code": "1910-2202S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2335.8, "discounted_cash": 1401.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 25MM SHORT HEAD HOLDING 00-5977-056-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-5977-056-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.0 MM LOCATING", "code_information": [{"code": "510-30-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 337.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.2 HEADLESS FLUTED STERILE BONE 800-02-505", "code_information": [{"code": "800-02-505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.2 THREADED SQUARE HEADED BONE 800-02-503", "code_information": [{"code": "800-02-503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4 X 0.9MM / .035 INCH K-WIRE 1600-435NS", "code_information": [{"code": "1600-435NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.28, "discounted_cash": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4 X 1.1MM / .045 INCH 1600-445NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1600-445NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9.28, "discounted_cash": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4 X 1.4MM / .054 INCH 1600-454NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1600-454NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9.28, "discounted_cash": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4 X 1.6MM / .062 INCH 1600-462NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1600-462NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9.28, "discounted_cash": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ANCHOR 120MM", "code_information": [{"code": "11-50001-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN AWL FIXATION DISP", "code_information": [{"code": "MB904R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.9, "discounted_cash": 178.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BOLT 3MM TO 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 471.64, "discounted_cash": 282.98, "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": 321.6, "discounted_cash": 192.96, "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": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 40MM X 2MM CORTICAL FREEZER DRIED ALLOFIX IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "400920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.2, "discounted_cash": 298.92, "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": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE KNEE 78MM LOCKING OSS POLYETHYLENE STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "150478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.8, "discounted_cash": 420.48, "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": 3550.0, "discounted_cash": 2130.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BUTTRESS 1.8MM X 18MM LOCKING VAR ANGLE W/ T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 194.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BUTTRESS 1.8MM X 20MM LOCKING VAR ANGLE W/ T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 194.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CENTERING 1.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "309.07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 208.5, "discounted_cash": 125.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COMPRESSION FT SOLID 1.9MM X 30MM AR-9919T-30S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9919T-30S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.8, "discounted_cash": 455.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COMPRESSION FT SOLID 1.9MM X 50MM AR-9919T-50S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9919T-50S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.8, "discounted_cash": 455.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COMPRESSION FT SOLID 2.4 MMX30MM AR-9924T-30S", "code_information": [{"code": "AR-9924T-30S", "type": "CDM"}], "standard_charges": [{"gross_charge": 758.8, "discounted_cash": 455.28, "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": 1304.18, "discounted_cash": 782.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COVERS BLUE 0.7IN X 0.125IN", "code_information": [{"code": "101002PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 2.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COVERS STRION ASSORT COLORS", "code_information": [{"code": "10-1-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.67, "discounted_cash": 4.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CR GUIDE SET PSI PSN 00-5970-000-67", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-5970-000-67", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1555.6, "discounted_cash": 933.36, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DBL TRO THR 0.177 DIA X 9IN KI-71-768", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KI-71-768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 58.76, "discounted_cash": 35.26, "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": 5.72, "discounted_cash": 3.43, "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": 281.35, "discounted_cash": 168.81, "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": 281.35, "discounted_cash": 168.81, "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": 164.8, "discounted_cash": 98.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 14MM TI STRL", "code_information": [{"code": "DP-14-TY", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.2, "discounted_cash": 51.12, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 2PK 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-521072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 2PK 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-521074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 2PK 16MM", "code_information": [{"code": "14-521076", "type": "CDM"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DORSAL BUTTRESS 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BP32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 880.0, "discounted_cash": 528.0, "setting": "both", "billing_class": 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"PIN STEINMANN 1.6MM 9 X .062 K-WIRE", "code_information": [{"code": "KM173-29-62", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.03, "discounted_cash": 22.22, "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": 604.15, "discounted_cash": 362.49, "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": 51.75, "discounted_cash": 31.05, "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"}], 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SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500019028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.6, "discounted_cash": 8.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 9IN X .142IN MICRO SMOOTH SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500019036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 9.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 9IN X .157IN MICRO SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500019040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 9.6, "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": 9.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN BLUNT PSN009", "code_information": [{"code": "PSN009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN BLUNT SIJ-N007", "code_information": [{"code": "SIJ-N007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SHARP PSN008", "code_information": [{"code": "PSN008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.25, "discounted_cash": 271.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SHARP SIJ-N008", "code_information": [{"code": "SIJ-N008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "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": 12.52, "discounted_cash": 7.51, "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": 23.66, "discounted_cash": 14.2, "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": 27.84, "discounted_cash": 16.7, "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": 66.96, "discounted_cash": 40.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN THREADED 300MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "X079-0057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN TROCAR POINT 2.0 X 230MM", "code_information": [{"code": "3811-1-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.94, "discounted_cash": 40.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN TROCAR W/ POINT 3.2 X 9 INCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "550-19-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 9.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN.035MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STIENMANN DOUBLE TROCAR 2.4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KI-71-753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.63, "discounted_cash": 53.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STIENMANN DOUBLE TROCAR 2.8MM", "code_information": [{"code": "KI-71-756", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.17, "discounted_cash": 52.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STIENMANN DOUBLE TROCAR 3.5MM", "code_information": [{"code": "KI-71-762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.77, "discounted_cash": 56.86, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STIENMANN DOUBLE TROCAR 4.0MM", "code_information": [{"code": "KI-71-765", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.85, "discounted_cash": 57.51, "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": 388.76, "discounted_cash": 233.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SURG 2.7MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MS2560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SURG 5MM APEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5027-1-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.08, "discounted_cash": 59.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SURG 5MM X 180MM X 50MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5018-6-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.96, "discounted_cash": 151.78, "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": 200.0, "discounted_cash": 120.0, "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": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIXATION PLATE TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIXATION SPINEART", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRY-IN 15 01-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMPORARY 198-1015", "code_information": [{"code": "198-1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMPORARY 6020-111", "code_information": [{"code": "6020-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TENSION BAND 70MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREADED 03 L70 269138", "code_information": [{"code": "269138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREAED 1.1MM X 102MM NON-STERILE 1600-462TNS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1600-462TNS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.52, "discounted_cash": 25.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TRANSFIXING 5/6 40MM X 300MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5050-4-300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TRANSFIXING 5/6 EXTERNAL FIXATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030-5-300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 240.72, "discounted_cash": 144.43, "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": 335.0, "discounted_cash": 201.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TROCHAR 1.6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MHP021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 22.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": 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"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": 5628.0, 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.67, "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": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": "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": 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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "UHC", "standard_charge_dollar": 8312.0, "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 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"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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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"standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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"methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 1958.0, "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": "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": 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": 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": "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 BREAST LOCALIZATION DEVICE/ ULTRASOUND; FIRST LESION 19285", "code_information": [{"code": "19285", "type": "CPT"}, {"code": "18125030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "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 INTERSTITIAL DEVICES FOR RADIATION THERAPY; PROSTATE 55876", "code_information": [{"code": "55876", "type": "CPT"}, {"code": "28070118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 5529.0, "discounted_cash": 3317.4, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2676.03, "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": "PLACEMENT OF SETON 46020", "code_information": [{"code": "46020", "type": "CPT"}, {"code": "9467887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.21, "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": "PLANT ANT CERV 1LVL 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-1-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5742.0, "discounted_cash": 3445.2, "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 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": "PLASTIC OPERATION OF PENIS FOR INJURY 54440", "code_information": [{"code": "54440", "type": "CPT"}, {"code": "1481620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "PLASTIC REPAIR OF INTROITUS 56800", "code_information": [{"code": "56800", "type": "CPT"}, {"code": "3170907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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 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combination", "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": 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": "PLATELETS PHERESIS PATH REDU", "code_information": [{"code": "P9073", "type": "HCPCS"}], "standard_charges": [{"minimum": 1560.63, "maximum": 2454.16, "setting": "outpatient", "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": "PLATES COMPRESSION,ATCS AR-19083", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-19083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.6, "discounted_cash": 422.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATES FIBULA TITANIUM AR-9963APLR-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9963APLR-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2601.6, "discounted_cash": 1560.96, "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": 744.65, "discounted_cash": 446.79, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "PLEDGET CARDIOVASCULAR LG 3/8IN X 3/16IN X 1/16IN DEKNATEL SOFT PTFE STRL", "code_information": [{"code": "L-705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.05, "discounted_cash": 42.63, "setting": "both", "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": "PLIF 11X23X5DEG -11 100-112305-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-112305-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 11X23X5DEG -12 100-112305-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-112305-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 11X23X5DEG -14 100-112305-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-112305-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 11X23X5DEG -8 100-112305-08", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "100-112305-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19000.0, "discounted_cash": 11400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X0DEG -9 100-092300-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092300-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9990.0, "discounted_cash": 5994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X5DEG -10 100-092305-10", "code_information": [{"code": "C1831", "type": "HCPCS"}, {"code": "100-092305-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X5DEG -11 100-092305-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092305-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22000.0, "discounted_cash": 13200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X5DEG -12 100-092305-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092305-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X5DEG -8 100-092305-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092305-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 9X23X5DEG -9 100-092305-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092305-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26400.0, "discounted_cash": 15840.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "PLUG CANAL MED 11MM TO 13MM CANALINTRAMEDULLARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 274.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CANAL SMINTRAMEDULLARY FOR 8 MM - 10 MM CANAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "130609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 313.2, "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": 158.4, "discounted_cash": 95.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG DEROTATION STANDARD SPINAL", "code_information": [{"code": "2000-1008", "type": "CDM"}], "standard_charges": [{"gross_charge": 1044.0, "discounted_cash": 626.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG FLANGE HELICAL CERVICO THORACIC IMP", "code_information": [{"code": "1200-2601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG HF CYPHER GREEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-500500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 687.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG LINEUM HELICAL FLANGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-524038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 258.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG LINEUM OCCIPITAL HF", "code_information": [{"code": "14-524045", "type": "CDM"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 504.0, "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": 550.43, "discounted_cash": 330.26, "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": 545.04, "discounted_cash": 327.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG STD HELICAL FLANGE FOR USE W/ POLARIS 5.5 TI DEFORMITY SCREW IMPLANT KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2000-1005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1044.0, "discounted_cash": 626.4, "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": 287.2, "discounted_cash": 172.32, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.06, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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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": 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"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 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, 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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"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": "POLARCUP INSERT XLPE SIZE 43/22 NON CEMENTED 11-000-588", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-000-588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2040.0, "discounted_cash": 1224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POLARCUP SHELL 43 CEMENTED 75100451", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "75100451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5220.0, "discounted_cash": 3132.0, "setting": "both", "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": "POLYETHYLENE INLAY W/TANTALUM MARKER/LARGE-10MM-STERILE PDL-L-PT10S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-PT10S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5810.0, "discounted_cash": 3486.0, "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": 31.32, "discounted_cash": 18.79, "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": 31.32, "discounted_cash": 18.79, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 2125.0, "discounted_cash": 1275.0, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1028.5, "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 3.5X14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FAAA35014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5800.0, "discounted_cash": 3480.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "PORT DETACHED CT VTX SLTIT 9.6 H787CT96STSD0", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "H787CT96STSD0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 342.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT HME FILTERED ADULT SMALL WITH GAS SAMPLING DYNJAAHME9", "code_information": [{"code": "DYNJAAHME9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.93, "discounted_cash": 4.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT IMPLANTABLE 6FR SLIM CATH POWERPORT", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "1716000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1023.0, "discounted_cash": 613.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT IMPLANTABLE 9.6FR OPEN ENDED PEEL APARTINF W/ PRE ATTACHED CATH TI", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "602270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1562.0, "discounted_cash": 937.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT IMPLANTABLE 9.6FRINF SNGL LUMEN W/ ATTACHED PERCUTANEOUSINTRODUCER SYS CATH", "code_information": [{"code": "C1788", 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{"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 CRADLE HEAD FOAM", "code_information": [{"code": "FP-HEADCR", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9.09, "discounted_cash": 5.45, "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": 34.44, "discounted_cash": 20.66, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HD 8IN X 11IN X 22IN RASPBERRY WDG FOAM WITHOUT COVER LF DISP", "code_information": [{"code": "NON081245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 17.08, "discounted_cash": 10.25, "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": 7.45, "discounted_cash": 4.47, "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": 34.16, "discounted_cash": 20.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER LEG PROCEDURE ACUFEX ACCESS ADV POS KIT 72205104", "code_information": [{"code": "72205104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.32, "discounted_cash": 195.79, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER LIMB FOR LAT OR BEACH CHAIR UC SPIDER 2", "code_information": [{"code": "72203733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 843.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER MASK BEACH CHAIR ERIN NON-STERILE 711001", "code_information": [{"code": "711001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.52, "discounted_cash": 46.51, "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": 136.68, "discounted_cash": 82.01, "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": 1297.23, "discounted_cash": 778.34, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONNING PIN AIRLOCK SPHERIC", "code_information": [{"code": "XPP01003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.1, "discounted_cash": 354.06, "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": 632.25, "discounted_cash": 379.35, "setting": "both", "billing_class": "facility"}]}, {"description": "POST FIXATION 10.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6105-0028-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1588.0, "discounted_cash": 952.8, "setting": "both", "billing_class": "facility"}]}, {"description": "POST FXTN 5MM X 25MM DOUBLE SPIKED PLATE LOW PROFILE ACLPCL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 225.6, "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", 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"standard_charges": [{"gross_charge": 1652.0, "discounted_cash": 991.2, "setting": "both", "billing_class": "facility"}]}, {"description": "POST TAPER 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PX11-0218-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1374.0, "discounted_cash": 824.4, "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": 814.0, "discounted_cash": 488.4, "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": 846.0, "discounted_cash": 507.6, "setting": "both", "billing_class": "facility"}]}, {"description": "POST TAPER HEMICAP 12MM FIX COMP", "code_information": [{"code": "L8631", "type": "HCPCS"}, {"code": "8156-0032-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1544.0, "discounted_cash": 926.4, "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 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"standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 6202.0, "discounted_cash": 3721.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", 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"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": 6202.0, "discounted_cash": 3721.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 3001.76, "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": "POSTERIOR SEGMENTAL INSTRUMENTATION 7 TO 12 VERTEBRAL SEGMENTS 22843", "code_information": [{"code": "22843", "type": "CPT"}, {"code": "6983445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9624.0, "discounted_cash": 5774.4, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4658.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3175.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "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": 2500.0, "discounted_cash": 1500.0, "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 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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. 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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 CHLORIDE 10 MEQ/100 ML IV SOL", "code_information": [{"code": "2B0826", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.34, "discounted_cash": 5.0, "setting": "both", "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 DRAINABLE COLOSTOMY CUT-TO-FIT", "code_information": [{"code": "22771", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.24, "discounted_cash": 10.94, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH MED 250 ML TO 500 ML PUMP DISP", "code_information": [{"code": "21-2171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.54, "discounted_cash": 41.12, "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": 201.66, "discounted_cash": 121.0, "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": 6.03, "discounted_cash": 3.62, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH WITH 1 SIDED COMFORT PANEL WITH FILTER 1-3/4 420695", "code_information": [{"code": "420695", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.53, "discounted_cash": 4.52, "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": 7.62, "discounted_cash": 4.57, "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": 3.0, "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": 6.96, "discounted_cash": 4.18, "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": 34.47, "discounted_cash": 20.68, "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": 34.47, "discounted_cash": 20.68, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER HEMOSTATIC SURGICEL ABSORBABLE", "code_information": [{"code": "3013SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.37, "discounted_cash": 298.42, "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": 325.67, "discounted_cash": 195.4, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER BOX NSK", "code_information": [{"code": "5770POWER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.6, "discounted_cash": 606.96, "setting": "both", "billing_class": "facility"}]}, {"description": "POWERPORT ISP M.R.I. IMPLANTABLE PORT WITH ATTACHABLE 8F CHRONOFLEX OPEN-ENDED SINGLE-LUMEN 1808060", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "1808060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 292.8, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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": "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": 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": "PRE BENT ROD 50MM MONT BLANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB1RL5550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 270.0, "setting": "both", "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": "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": "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": "PREGNANCY TEST URINE DIPSTICK", "code_information": [{"code": "4582105026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": "PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE-BREAST 19290", "code_information": [{"code": "1481627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 666.0, "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": 32.95, "discounted_cash": 19.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "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": "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 KIT CENTRAL LINE DRESSING (HUBER)", "code_information": [{"code": "DYND75221H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.97, "discounted_cash": 13.18, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 2235.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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"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", 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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"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 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"AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": 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{"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 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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"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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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"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": 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 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"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 PARTIAL SHOULDER - ASCEND FLEX CAPFLEXTSA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPFLEXTSA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "PRIMARY REPAIR TENDON/MUSCLE FLEXOR FOREARM/WRIST-SINGLE EACH TENDON 25260", "code_information": [{"code": "25260", 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"standard_charge_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": 1519.76, "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": "PRIMARY TOTAL SHOULDER REPLACEMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SHOPTR BMT CAP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26000.0, "discounted_cash": 15600.0, "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", 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"standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "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": 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"standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", 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8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"plan_name": "UHC", "standard_charge_dollar": 2989.0, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 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"discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS, HIP REDAPT MODULAR SHELL 50MM 71352350", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71352350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 144.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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[{"code": "2D72NS55X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEXIS POWDER-FREE LATEX SURGICAL GLOVES SIZE 6.5 2D72NT65X", "code_information": [{"code": "2D72NT65X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.09, "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", "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": 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": 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": 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": 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": 0.51, "methodology": "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": 1843.66, "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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "PROVENDA AMNIOTIC MEMBRANE ALLOGRAFT 2.0X3.0", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "BPRD0203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6300.0, "discounted_cash": 3780.0, "setting": "both", "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": "PROXIMAL COMPONENT 10P PYRO CARDBON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-200-10P-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3690.0, "discounted_cash": 2214.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROXIMAL COMPONENT 30P PYRO CARBON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-200-30P-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3690.0, "discounted_cash": 2214.0, "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": 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": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 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 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WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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{"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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", 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"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"}, 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{"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", 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"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 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"plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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, 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6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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{"code": "633794", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 295.0, "discounted_cash": 177.0, "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": 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": 109.56, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": "PULSAVAC PLUS FAN KIT 00515047500", "code_information": [{"code": "515047500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.45, "discounted_cash": 83.07, "setting": "both", "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": 85342.0, "discounted_cash": 51205.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP 5.0ML/HR ACCUFUSER DISP SILICON INFUSER", "code_information": [{"code": "T5015L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 508.56, "discounted_cash": 305.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP ON-Q 400ML PM026-A", "code_information": [{"code": "PM026-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.4, "discounted_cash": 323.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 100 ML X 1 ML PER HR SOAKER", "code_information": [{"code": "PM036-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.13, "discounted_cash": 176.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 100 ML X 2 ML/HR 2.5IN SOAKER CATH", "code_information": [{"code": "7000223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 351.05, "discounted_cash": 210.63, "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": 547.95, "discounted_cash": 328.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 270 ML 4 ML/HR DUAL ONQ SILVERSOAKER", "code_information": [{"code": "PM015-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.95, "discounted_cash": 275.37, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 270 ML X 4 ML", "code_information": [{"code": "7000225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.75, "discounted_cash": 291.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 270 ML X 4 ML/HR 5IN SOAKER CATH", "code_information": [{"code": "7000226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.31, "discounted_cash": 286.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMPINFUSION ON Q C BLOC 100 ML X 2 ML PER HOUR W/ SELECT A FLOW CATH", "code_information": [{"code": "PM012-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.21, "discounted_cash": 186.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH APOLLO DISP", "code_information": [{"code": "-45P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.9, "discounted_cash": 229.14, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "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": "PUNCH GALEN 4.5 OI-45P", "code_information": [{"code": "OI-45P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 547.95, "discounted_cash": 328.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH SURG 3.5MM FOR PUSHLOCK", "code_information": [{"code": "AR-1926P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.05, "discounted_cash": 345.63, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TAP 5.5MM FULLY THREADED SHOUDLER FOR USE W/ 5.5 MM AND 6.5 MM CORKSCREW A", "code_information": [{"code": "AR-1927PB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.9, "discounted_cash": 320.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BREAST", "code_information": [{"code": "19000", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE 61070", "code_information": [{"code": "61070", "type": "CPT"}, {"code": "2401959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PLATFORM CM 10CC", "code_information": [{"code": "CM68910", "type": "CDM"}], "standard_charges": [{"gross_charge": 4410.0, "discounted_cash": 2646.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PLATFORM CM 2CC", "code_information": [{"code": "CM68902", "type": "CDM"}], "standard_charges": [{"gross_charge": 998.0, "discounted_cash": 598.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PLATFORM CM SCC", "code_information": [{"code": "CM6890S", "type": "CDM"}], "standard_charges": [{"gross_charge": 2206.0, "discounted_cash": 1323.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PROPEL LARGE 5020010", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "5020010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2896.0, "discounted_cash": 1737.6, 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ZVPRO 1.00CC ZVP-01.00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ZVP-01.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY ZVPRO 10.00CC ZVP-10.00", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ZVP-10.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY ZVPRO 2.50CC ZVP-02.50", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "ZVP-02.50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2126.0, "discounted_cash": 1275.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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", 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CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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"outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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 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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": 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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 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"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": 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": 295.0, "discounted_cash": 177.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.31, "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": 109.56, "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 Performance Test Units", "code_information": [{"code": "97750", "type": "CPT"}, {"code": "1565122", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 157.35, "maximum": 8450.0, "gross_charge": 256.0, "discounted_cash": 153.6, "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": 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": "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, 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"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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 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 PPO", "additional_payer_notes": "No historical data found for 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": "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": 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&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "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 PPO", "additional_payer_notes": "No historical data found for 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": 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": "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": 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": 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 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 403.0, "discounted_cash": 241.8, "setting": "both", "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 OSTEO BLADE SZ 14 71369314", "code_information": [{"code": "71369314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.03, "discounted_cash": 244.82, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD OSTEO BLADE SZ 16 71369316", "code_information": [{"code": "71369316", "type": "CDM"}], "standard_charges": [{"gross_charge": 340.03, "discounted_cash": 204.02, "setting": "both", "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 1952.0, "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", "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": 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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 219.36, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 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", "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": 219.36, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "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": 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": 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", "standard_charge_dollar": 4620.0, "methodology": "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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 218.28, "methodology": "fee schedule"}, {"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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 1301.0, "methodology": "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 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": 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 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "setting": "both", "payers_information": 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 6167.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 2076.69, "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": 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": "RADIUS SEGMENT <15CM FD", "code_information": [{"code": "45\u00c2\u00b70363", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "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": 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"billing_class": "facility"}]}, {"description": "RASP RECIPROCATING 17.1MM X 8.8MM LG COTTLE REPROCESS", "code_information": [{"code": "510037125R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.82, "discounted_cash": 130.09, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP SURG 11MM X 5MM SM TEAR CROSS CUTINSTR", "code_information": [{"code": "5100-037-113 (d)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.9, "discounted_cash": 108.54, "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": 219.43, "discounted_cash": 131.66, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP SURG 17MM X 3.2MM MED U SERIESINSTR", "code_information": [{"code": "5120080030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.62, "discounted_cash": 207.37, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.07, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 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"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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.5, "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": 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": 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{"payer_name": "AETNA", "plan_name": "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": 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{"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", 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8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-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": 1087.63, "discounted_cash": 652.58, "setting": "both", "billing_class": 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"code_information": [{"code": "26437", "type": "CPT"}, {"code": "1481688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 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{"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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 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"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 LOWER LEG", "code_information": [{"code": "27712", "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", 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total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": 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"billing_class": "facility"}]}, {"description": "REAMER 12MM RIGID PROX", "code_information": [{"code": "1806-2014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.83, "discounted_cash": 328.1, "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": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.0 QUICK COUPLING ANC088C", "code_information": [{"code": "ANC088C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "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": 941.35, 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"billing_class": "facility"}]}, {"description": "REAMER MALE 21MM DISP", "code_information": [{"code": "P01-900-2103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1488.5, "discounted_cash": 893.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER METATARSAL 16MM", "code_information": [{"code": "AR-8944MR-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1246.5, "discounted_cash": 747.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MODULAR CENTER POST SBGL3007", "code_information": [{"code": "SBGL3007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 896.39, "discounted_cash": 537.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MTP CONE 16MM GEN 2 58890216", "code_information": [{"code": "58890216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 688.45, "discounted_cash": 413.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER NEXIS VAR", "code_information": [{"code": "XRE01001D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.16, "discounted_cash": 448.9, "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": 469.0, "discounted_cash": 281.4, "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": 469.0, "discounted_cash": 281.4, "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": 469.0, "discounted_cash": 281.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PHALANGEAL 16MM", "code_information": [{"code": "AR-8944PR-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1264.5, "discounted_cash": 758.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 16MM CONVEX", "code_information": [{"code": "XFR004216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1436.06, "discounted_cash": 861.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONCAVE", "code_information": [{"code": "XFR004118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1436.06, "discounted_cash": 861.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONVEX", "code_information": [{"code": "XFR004218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1890.0, "discounted_cash": 1134.0, "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": 1121.54, "discounted_cash": 672.92, "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": 1365.6, "discounted_cash": 819.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 41MM PATELLA", "code_information": [{"code": "5979-95-41", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 338.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 51MM PATELLA", "code_information": [{"code": "5979-95-51", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 338.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 7.5MM ACORNINSTR", "code_information": [{"code": "232403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 7MM FULLY FLUTED STRLINSTR", "code_information": [{"code": "232415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURGACING INTRAMEDULLARY IMPLANT INSTR", "code_information": [{"code": "XFR001001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.5, "discounted_cash": 951.3, "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 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"HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "UHC", "standard_charge_dollar": 9735.0, "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 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"HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "RECHARGER BELT LARGE FP9000L", "code_information": [{"code": "FP9000L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "RECONST LWR JAW W/FIXATION", "code_information": [{"code": "21196", "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": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"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": "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": 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": "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": 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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 16063.0, "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 WALMART ACO", "standard_charge_dollar": 14250.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "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": 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": "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": 4620.0, "methodology": "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": "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": 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": "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": 4620.0, "methodology": "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": "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": 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": 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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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": 9357.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 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": 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": "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": 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": 9357.0, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "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": 2989.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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"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": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "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": 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": "RECONSTRUCTION BREAST W/ FREE FLAP 19364", "code_information": [{"code": "19364", "type": "CPT"}, {"code": "1481693", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.66, "maximum": 9357.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 2046.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAST WITH IMPLANT 19325", "code_information": [{"code": "19325", "type": "CPT"}, {"code": "1481695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3001.76, "maximum": 9735.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2279.15, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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"methodology": "fee schedule"}, {"payer_name": "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 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"plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"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 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2279.15, "methodology": "fee schedule"}, {"payer_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": 2279.15, "maximum": 9357.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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": 2279.15, "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": 4709.0, "discounted_cash": 2825.4, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2279.15, "methodology": "fee schedule"}, {"payer_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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 5628.0, "discounted_cash": 3376.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "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 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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 2518.0, "methodology": "fee 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": 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 NAIL BED WITH GRAFT 11762", "code_information": [{"code": "11762", "type": "CPT"}, {"code": "2580861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2685.0, "discounted_cash": 1611.0, "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": 1299.54, "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": "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": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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 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"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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "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": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "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": "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 W/ IMPLANT 21390", "code_information": [{"code": "21390", "type": "CPT"}, {"code": "1481724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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 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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee 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{"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": 2279.15, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 568.5, "discounted_cash": 341.1, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 703.14, "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "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": 5628.0, "discounted_cash": 3376.8, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "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": 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1519.76, "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": 6074.0, "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 PROCIDENTIA UNDER ANESTHESIA 45900", "code_information": [{"code": "45900", "type": "CPT"}, {"code": "1481740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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", 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"fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 2723.95, "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", 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"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 95990", "code_information": [{"code": "95990", "type": "CPT"}, {"code": "2401960", "type": "CDM"}, {"code": "949", "type": "RC"}], "standard_charges": [{"minimum": 416.39, "maximum": 8450.0, "gross_charge": 957.0, "discounted_cash": 574.2, "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": 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "REFILL/MAINT PUMP/RESVR SYST", "code_information": [{"code": "96522", "type": "CPT"}], "standard_charges": [{"minimum": 537.18, "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": 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": "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "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": "REINSERTION OF SPINAL FIXATION DEVICE 22849", "code_information": [{"code": "22849", "type": "CPT"}, {"code": "1481743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.66, "maximum": 14796.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 2046.66, "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": 5628.0, "discounted_cash": 3376.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": 9357.0, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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 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 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "RELEASE SPINAL CORD LUMBAR", "code_information": [{"code": "63200", "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": "RELEASE TENDON ADDUCTOR HIP-OPEN 27001", "code_information": [{"code": "27001", "type": "CPT"}, {"code": "1481753", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "RELEASE TENDON ADDUCTOR HIP-PERCUTANEOUS 27000", "code_information": [{"code": "27000", "type": "CPT"}, {"code": "1481752", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 4465.5, "discounted_cash": 2679.3, "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": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "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": "RELINE TP W 10MM HOOK 10200046", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10200046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1993.6, "discounted_cash": 1196.16, "setting": "both", "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": 252.82, "discounted_cash": 151.69, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD ETHIBOND CANOE NEEDLE SW110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SW110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38.75, "discounted_cash": 23.25, "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": 150.0, "discounted_cash": 90.0, "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": 273.94, "discounted_cash": 164.36, "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": 298.13, "discounted_cash": 178.88, "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": 319.2, "discounted_cash": 191.52, "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": 200.15, "discounted_cash": 120.09, "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": 147.88, "discounted_cash": 88.73, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SIGNIA TRI-STAPLE BUTTRESS MED SIGTRSB60AMT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIGTRSB60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1676.1, "discounted_cash": 1005.66, "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": 409.67, "discounted_cash": 245.8, "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": 78.91, "discounted_cash": 47.35, "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": 74.4, "discounted_cash": 44.64, "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": 226.85, "discounted_cash": 136.11, "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": 140.09, "discounted_cash": 84.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 60MM 12MM BLACK LAP LINEAR CUTTER ECHELON LF STRLINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.7, "discounted_cash": 146.22, "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": 1286.69, "discounted_cash": 772.01, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "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": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "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 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"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 ANTERIOR INSTRUMENTATION SPINE 22855", "code_information": [{"code": "22855", "type": "CPT"}, {"code": "1481782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 940.83, "maximum": 9735.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 1379.88, "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": 940.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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": 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"plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 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"standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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{"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": 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-REQUIRING GENERAL ANESTHESIA 30310", "code_information": [{"code": "30310", "type": "CPT"}, {"code": "1481775", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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 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"standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "setting": "both", 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "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": 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": 537.24, "maximum": 8450.0, 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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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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"standard_charge_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": 1519.76, "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": "REMOVAL IMPACTED CERUMEN W/INST. 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1519.76, "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; HUMERAL AND ULNAR 24160", "code_information": [{"code": "24160", "type": "CPT"}, {"code": "2401681", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "REMOVAL IMPLANT-DEEP 20680", "code_information": [{"code": "20680", "type": "CPT"}, {"code": "1481786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "REMOVAL IMPLANT-SUPERFICIAL 20670", 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "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 NON INFECTED MESH AT TIME OF INI. 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 520.78, "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": "REMOVAL OF ANAL SETON 46030", "code_information": [{"code": "46030", "type": "CPT"}, {"code": "15821347", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "REMOVAL OF ANKLE IMPLANT 27704", "code_information": [{"code": "27704", "type": "CPT"}, {"code": "1807652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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": "61516", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "61536", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 BROW WRINKLES", "code_information": [{"code": "15826", "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": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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/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 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 EMBEDDED FOREIGN BODY; EYELID 67938", "code_information": [{"code": "67938", "type": "CPT"}, {"code": "25254048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"43285", "type": "CPT"}, {"code": "44660559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2723.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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": 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": 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": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "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": 2989.0, "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 FALLOPIAN TUBE", "code_information": [{"code": "58700", "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": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 998.0, "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": 516.91, "maximum": 8450.0, "gross_charge": 1068.0, "discounted_cash": 640.8, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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 SCROTUM 55120", "code_information": [{"code": "55120", "type": "CPT"}, {"code": "1481791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_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": 537.24, "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-EXTERNAL EYE; CONJUNCTIVAL-SUPERFICIAL 65205", "code_information": [{"code": "65205", "type": "CPT"}, {"code": "1481793", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 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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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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"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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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 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historical data found for payer/plan and coding 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 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "47605", "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": 5892.0, "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": "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": 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": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "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": "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": 4620.0, "methodology": "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 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": 4620.0, "methodology": "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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-POSTERIOR SEGMENT-EXTRAOCULAR 67120", "code_information": [{"code": "67120", "type": "CPT"}, {"code": "1481800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 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": 6074.0, "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": 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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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historical data found for payer/plan and coding 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; ASPIRATION TECHNIQUE-1 OR MORE STAGES 66840", "code_information": [{"code": "66840", "type": "CPT"}, {"code": "1481802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 2019.24, "maximum": 9357.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": 9357.0, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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 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 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 LYMPH NODES NECK", "code_information": [{"code": "38724", "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 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"AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"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 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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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 OMENTUM", "code_information": [{"code": "49255", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": 8312.0, "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 OVARY/TUBE(S)", "code_information": [{"code": "58720", "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PENIS", "code_information": [{"code": "54125", "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": "REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY 49402", "code_information": [{"code": "49402", "type": "CPT"}, {"code": "16830123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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 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": 1719.0, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PROSTHETIC MATERIAL OR MESH; ABDOMINAL WALL FOR INFECTION 11008", "code_information": [{"code": "11008", "type": "CPT"}, {"code": "10171439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 996.27, "maximum": 8450.0, "gross_charge": 3019.0, "discounted_cash": 1811.4, "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": 1461.19, "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": 996.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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 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", "code_information": [{"code": "21615", "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": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 SKIN WRINKLES", "code_information": [{"code": "15829", "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 SKULL LESION", "code_information": [{"code": "61500", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "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": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 3140.0, "discounted_cash": 1884.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 8312.0, "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": 3140.0, "discounted_cash": 1884.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "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": "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": 4172.0, "discounted_cash": 2503.2, "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": 9735.0, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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 SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL)-OTHER SURGEON 15851", "code_information": [{"code": "15851", "type": "CPT"}, {"code": "1481819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2989.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 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": 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": 9357.0, "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 THYROID", "code_information": [{"code": "60270", "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": "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 TOTAL DISC ARTHROPLASTY; ANTERIOR; SINGLE; CERVICAL 22864", "code_information": [{"code": "22864", "type": "CPT"}, {"code": "44717147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1967.46, "maximum": 9735.0, "gross_charge": 5962.0, "discounted_cash": 3577.2, "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": 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": 2885.6, "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": 1967.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 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 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": 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": 5892.0, "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": 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": "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": 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": "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": 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": 5892.0, "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 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"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 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": 4620.0, "methodology": "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": 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"standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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{"payer_name": "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 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"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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", 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coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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"}], 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"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 SUTURE OR THIERSCH WIRE-ANAL CANAL 46754", "code_information": [{"code": "46754", "type": "CPT"}, {"code": "1481821", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 1322.0, "discounted_cash": 793.2, "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 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[{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "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": 2851.0, "discounted_cash": 1710.6, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1379.88, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 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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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 CAVITY SHUNT", "code_information": [{"code": "62256", "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": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 CERCLAGE SUTURE", "code_information": [{"code": "59871", "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": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "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": 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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 CONTRACEPTIVE CAPSULE", "code_information": [{"code": "11976", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 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": 4620.0, "methodology": "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", "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": 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 EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22103", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22116", "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE 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": 4620.0, "methodology": "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": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "REMOVE EYELID LESIONS", "code_information": [{"code": "67805", "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "68110", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 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": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 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": 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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "65210", "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 FROM EYE", "code_information": [{"code": "65265", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "27086", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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 IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2827.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "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 NASAL FOREIGN BODY", "code_information": [{"code": "30300", "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 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": 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": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22110", "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": 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": "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 PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 PROSTATE REGROWTH", "code_information": [{"code": "52630", "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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 SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 SPERM DUCT POUCH", "code_information": [{"code": "55650", "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": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 SPINE LAMINA 1/2 SCRL", "code_information": [{"code": "63011", "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": 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 SPINE LAMINA 1/2 THRC", "code_information": [{"code": "63003", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 SPINE LAMINA >2 THRC", "code_information": [{"code": "63016", "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": 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 STENT VIA TRANSURETH", "code_information": [{"code": "50386", "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": 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": "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": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 URO SPHINCTER", "code_information": [{"code": "53446", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "UHC", "standard_charge_dollar": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "63090", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "63085", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 XDRL BODY CRVCL", "code_information": [{"code": "63300", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "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": 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/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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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/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": 4.14, "discounted_cash": 2.48, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "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": 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": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "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": 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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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 FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": 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"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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.17, "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": "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": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "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": 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": "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 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"60-7075-107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.96, "discounted_cash": 29.38, "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": 48.96, "discounted_cash": 29.38, "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": 53.01, "discounted_cash": 31.81, "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": 119.95, "discounted_cash": 71.97, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DRILL BIT FAST 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"billing_class": "facility"}]}, {"description": "REP RETRIEVER SUTURE HOFFEE BLUE LASSO", "code_information": [{"code": "22701R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.11, "discounted_cash": 49.87, "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": 81.75, "discounted_cash": 49.05, "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": 86.4, "discounted_cash": 51.84, "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"}], 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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": 8598.0, "discounted_cash": 5158.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 4161.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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. 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ABD. HERNIA RECURRENT INC. IMPLANT MESH GREATER THAN 10 CM 49617", "code_information": [{"code": "49617", "type": "CPT"}, {"code": "46163793", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1987.26, "maximum": 9735.0, "gross_charge": 6022.0, "discounted_cash": 3613.2, "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": 2914.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1987.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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 RECURRENT INC. IMPLANT MESH GREATER THAN 10 CM INCARCERATED 49618", "code_information": [{"code": "49618", "type": "CPT"}, {"code": "46163796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1987.26, "maximum": 9735.0, "gross_charge": 6022.0, "discounted_cash": 3613.2, "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": 2914.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1987.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "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 RECURRENT INC. MESH 3 CM TO 10 CM 49615", "code_information": [{"code": "49615", "type": "CPT"}, {"code": "46163791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1875.01, "maximum": 8450.0, "gross_charge": 3874.0, "discounted_cash": 2324.4, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 1875.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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 RECURRENT INC. MESH 3 CM TO 10 CM INCARCERATED 49616", "code_information": [{"code": "49616", "type": "CPT"}, {"code": "46163792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1409.76, "maximum": 9735.0, "gross_charge": 4272.0, "discounted_cash": 2563.2, "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": 2067.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1409.76, "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": "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": 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": 8312.0, "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 NECK", "code_information": [{"code": "51845", "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": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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": 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": 8312.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 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": 9735.0, "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": "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": "35226", "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": 2827.0, "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": "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": 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": "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": 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": "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": 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": "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": 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": 8312.0, "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": 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": 9735.0, "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": 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": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR 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": "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 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 BROW DEFECT", "code_information": [{"code": "67900", "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": "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": 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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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 COMPLEX SCALP ARMS AND/OR LEGS 1.1CM 13120", "code_information": [{"code": "13120", "type": "CPT"}, {"code": "1700055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 EA ADD 5CM 13122", "code_information": [{"code": "13122", "type": "CPT"}, {"code": "1643966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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 ARM ARTERY", "code_information": [{"code": "35045", "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 DIAPHRAGMATIC HERNIA; ACUTE 39540", "code_information": [{"code": "39540", "type": "CPT"}, {"code": "35114247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 365.97, "maximum": 8450.0, "gross_charge": 1109.0, "discounted_cash": 665.4, "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": 536.75, "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": 365.97, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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 DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "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 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W/GRAFT 26434", "code_information": [{"code": "26434", "type": "CPT"}, {"code": "1480286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 HAND W/ FREE GRAFT-EACH TENDON 26412", "code_information": [{"code": "26412", "type": "CPT"}, {"code": "1481854", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 WOUND", "code_information": [{"code": "67935", "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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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"methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 3140.0, "discounted_cash": 1884.0, "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 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": 2989.0, "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 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"UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2019.24, "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": 8312.0, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 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": 2019.24, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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, 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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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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"standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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 INTRINSIC MUSCLES HAND EACH 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"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 LEG FASCIA DEFECT", "code_information": [{"code": "27656", "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 MULTI-COMP PENIS PROS", "code_information": [{"code": "54408", "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 NASAL SEPTAL PERFORATIONS 30630", "code_information": [{"code": "30630", "type": "CPT"}, {"code": "1700100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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", 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"plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4417.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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. 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2279.15, "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/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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"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": 1461.19, "maximum": 8450.0, "gross_charge": 3019.0, "discounted_cash": 1811.4, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 1461.19, "methodology": "fee schedule"}, {"payer_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": 2019.24, "maximum": 9735.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, 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{"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": 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": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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", 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"methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "51860", "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": 6074.0, "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": 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 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"standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 1519.76, "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": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": 1519.76, "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": 8312.0, "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": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "REPAIR OF CIRCUMCISION", "code_information": [{"code": "54163", "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": 6074.0, "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 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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": 5628.0, "discounted_cash": 3376.8, "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", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "setting": "both", "payers_information": 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"maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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", 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"CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 5892.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 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"standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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 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"fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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OF UVEAL TISSUE 65285", "code_information": [{"code": "65285", "type": "CPT"}, {"code": "1481952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": "REPAIR OF LACERATION CONJUNCTIVA-DIRECT CLOSURE 65270", "code_information": [{"code": "65270", "type": "CPT"}, {"code": "1481955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 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": "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": 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": "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": 3140.0, "discounted_cash": 1884.0, "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": 5628.0, "discounted_cash": 3376.8, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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 OR MALUNION TIBIA W/ILIAC OR OTHER AUTOGRAFT 27724", "code_information": [{"code": "27724", "type": "CPT"}, {"code": "5561471", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 10065.0, "discounted_cash": 6039.0, "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": 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": 4871.46, "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": 3321.45, "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": "REPAIR OF NONUNION OR MALUNION TIBIA W/O GRAFT 27720", "code_information": [{"code": "27720", "type": "CPT"}, {"code": "8403954", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1379.88, "maximum": 9735.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 1379.88, "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": "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "methodology": "fee schedule"}, {"payer_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 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": 5628.0, "discounted_cash": 3376.8, "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": 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"standard_charge_dollar": 9357.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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 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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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 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"payers_information": [{"payer_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 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PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2019.24, "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": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": 2989.0, "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 TUNICA VAGINALIS HYDROCELE 55060", "code_information": [{"code": "55060", "type": "CPT"}, {"code": "1481970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 DEFECT", "code_information": [{"code": "31825", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 OVAL WINDOW FISTULA 69666", "code_information": [{"code": "69666", "type": "CPT"}, {"code": "3532521", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "methodology": "fee schedule"}, {"payer_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 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": 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 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"UHC", "standard_charge_dollar": 8312.0, "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": 4073.4, "discounted_cash": 2444.04, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "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": "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 PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "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": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 PENIS", "code_information": [{"code": "54380", "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 PENIS", "code_information": [{"code": "54385", "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": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "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": "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": 5628.0, "discounted_cash": 3376.8, "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": "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": 2279.15, "maximum": 9357.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2279.15, "methodology": "fee schedule"}, {"payer_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 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"CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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-VAGINA FISTULA", "code_information": [{"code": "57305", "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 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33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 5204.0, "discounted_cash": 3122.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "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": 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 ROUND WINDOW FISTULA 69667", "code_information": [{"code": "69667", "type": "CPT"}, {"code": "1994343", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 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 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"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": 3001.76, "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": 9357.0, "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": 3001.76, "maximum": 9357.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": "42500", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": 3365.0, "methodology": "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": 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": 3365.0, "methodology": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "REPAIR SYSTEM FXBRIDGE TUBEROSITY AR-9517", "code_information": [{"code": "AR-9517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2482.36, "discounted_cash": 1489.42, "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": 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data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4709.0, "discounted_cash": 2825.4, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2279.15, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": "49600", "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": "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": 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": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 URETHROVAGINAL LESION", "code_information": [{"code": "57311", "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": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 VESSEL-HAND/FINGER 35207", "code_information": [{"code": "35207", "type": "CPT"}, {"code": "1481997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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 VESSEL-UPPER EXTREMITY 35206", "code_information": [{"code": "35206", "type": "CPT"}, {"code": "1482001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1379.88, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "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": 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": 1379.88, "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 WINDPIPE OPENING", "code_information": [{"code": "31613", "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 WINDPIPE OPENING", "code_information": [{"code": "31614", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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": 518.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 518.0, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 1110.0, "discounted_cash": 666.0, "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", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "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": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"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 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"UHC", "standard_charge_dollar": 5892.0, "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": 1027.53, "maximum": 9357.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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 TOTAL KNEE CAP PRICE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CTKI", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "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": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 5628.0, "discounted_cash": 3376.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for 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": 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": 2827.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 INTRAOCULAR LENS", "code_information": [{"code": "66825", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 50.54, "discounted_cash": 30.32, "setting": "both", "billing_class": "facility"}]}, {"description": "REPR CUFF TOURNIQUET 34IN X 4IN 2 PORT 1 BLADDER LN CONN", "code_information": [{"code": "60-7070-106-00R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.54, "discounted_cash": 30.32, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 HOVERMATT 34 X 78 HM34SPUR", "code_information": [{"code": "HM34SPUR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.14, "discounted_cash": 19.28, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER BLADE 4MM 375542000RH", "code_information": [{"code": "375542000RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.23, "discounted_cash": 54.74, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER BLADE SMALL JOINT 2.5MM 375628000RH", "code_information": [{"code": "375628000RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.36, "discounted_cash": 49.42, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER BLADE TOMCAT 5.5MM 375565000RH", "code_information": [{"code": "375565000RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.36, "discounted_cash": 49.42, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER BURR 4MM 375940012RH", "code_information": [{"code": "375940012RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.36, "discounted_cash": 49.42, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER SERFAS PROBE 90-S CRUISE 279401200RH", "code_information": [{"code": "279401200RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.6, "discounted_cash": 132.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCS SYSTEM CANNULA CLEAR DISTAL RIB SMOOTH 7MM X 75MM", "code_information": [{"code": "214115R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.81, "discounted_cash": 34.09, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.12, "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": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 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 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 ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "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": "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 FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 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": "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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": "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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/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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "RESECTION OF OR TRANSPLANTATION OF LONG TENDON OF BICEPS 23440", "code_information": [{"code": "23440", "type": "CPT"}, {"code": "1792996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 3001.76, "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": "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": 5529.0, "discounted_cash": 3317.4, "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2676.03, "methodology": "fee schedule"}, {"payer_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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 1379.88, "maximum": 8450.0, "gross_charge": 2851.0, "discounted_cash": 1710.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1379.88, "methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "RESECTOR MERLIN 3.5MM FULL RADIUS REPROCESS STERLINGINSTR", "code_information": [{"code": "C9248R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.9, "discounted_cash": 45.54, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR OPAT QUICK CONNECT", "code_information": [{"code": "OPT-R-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.47, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4827.47, "maximum": 8287.56, "estimated_discounted_cash": 2450.96, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.52, "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": "RESTRICTOR CEMENT TOTAL ELBOW COONRAD MORREY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 244.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RESUSCITATOR INFANT MASK 40 TUBING LF 2K8010", "code_information": [{"code": "2K8010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.87, "discounted_cash": 29.32, "setting": "both", "billing_class": "facility"}]}, {"description": "RESUSCITATOR MANUAL ADLT MASK BAG RES CPRM1116", "code_information": [{"code": "CPRM1116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.45, "discounted_cash": 37.47, "setting": "both", "billing_class": "facility"}]}, {"description": "RETIC", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "1233836", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 116.0, "discounted_cash": 69.6, "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": 6.16, "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": 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": "RETICULATED PLATELET ASSAY", "code_information": [{"code": "85055", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 44.68, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.6, "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": 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": 835.38, "discounted_cash": 501.23, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR 15MM HOHMANN AR-8943-22", "code_information": [{"code": "AR-8943-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR GRAFT MALLEABLE SURGICAL RAPIDLOC MENISCAL REPAIR", "code_information": [{"code": "232024R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.61, "discounted_cash": 274.57, "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": 728.04, "discounted_cash": 436.82, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR O C-SECTIONS", "code_information": [{"code": "G6313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.79, "discounted_cash": 155.27, "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": 94.43, "discounted_cash": 56.66, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SHIM SHARP 6705-004", "code_information": [{"code": "6705-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 207.7, "discounted_cash": 124.62, "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": 186.33, "discounted_cash": 111.8, "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": 186.33, "discounted_cash": 111.8, "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": 142.0, "discounted_cash": 85.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 506.5, "discounted_cash": 303.9, "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": 853.2, "discounted_cash": 511.92, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER NET 2.5MM SHEATH 230 CM 3 CM X 6 CM NET ROTH FOREIGN BODY", "code_information": [{"code": "711050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1264.5, "discounted_cash": 758.7, "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": 101.85, "discounted_cash": 61.11, "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": 190.03, "discounted_cash": 114.02, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER SUTURE HOFFEE BLUE LASSO", "code_information": [{"code": "22701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.75, "discounted_cash": 95.85, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.23, "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": "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23474", "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "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": "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 EXTERNAL EAR", "code_information": [{"code": "69300", "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": "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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(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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 PENIS/URETHRA", "code_information": [{"code": "54328", "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": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "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": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "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": 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": "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": 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "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": "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 VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "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": 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 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": 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": "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/REMOVE SLING REPAIR", "code_information": [{"code": "57287", "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": 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": "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": 3841.0, "discounted_cash": 2304.6, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1859.04, "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": 2019.24, "maximum": 8450.0, "gross_charge": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": "59320", "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 EYELID", "code_information": [{"code": "21280", "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": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "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": 2989.0, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "REVISION OF EYELID", "code_information": [{"code": "67966", "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": "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": 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": "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": 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": "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": 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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "REVISION OF IRIS", "code_information": [{"code": "66761", "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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": "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": 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": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "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": "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 EYELID", "code_information": [{"code": "15821", "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 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 NOSE", "code_information": [{"code": "30460", "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 NOSE", "code_information": [{"code": "30462", "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": "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": "54304", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 5161.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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 UPPER EYELID", "code_information": [{"code": "15822", "type": 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"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2723.95, "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 3841.0, "discounted_cash": 2304.6, "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1859.04, "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 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"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 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{"payer_name": "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": "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 PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "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": 3365.0, "methodology": "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": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "RF CANNULA VENOM CVD 18G 100MM", "code_information": [{"code": "406-860-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.37, "discounted_cash": 168.82, "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": 303.88, "discounted_cash": 182.33, "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", 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"facility"}]}, {"description": "RING FOOT LONG 140MM 4934-4-140", "code_information": [{"code": "4934-4-140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5419.06, "discounted_cash": 3251.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RING FULL CARBON 140MM 4933-5-140", "code_information": [{"code": "4933-5-140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4049.34, "discounted_cash": 2429.6, "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": 258.79, "discounted_cash": 155.27, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRACTOR LONESTAR", "code_information": [{"code": "3307G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.96, "discounted_cash": 123.58, "setting": "both", "billing_class": "facility"}]}, {"description": "RING SIZE 1 ADAPTER 8RC1-5001-A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8RC1-5001-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 860.0, "discounted_cash": 516.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RING XE FIX 155MM FOOT LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4934-4-155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2940.0, "discounted_cash": 1764.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for 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": 1958.0, "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 9735.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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 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": 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": 9735.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 5892.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "ROB 5.5 X 500MM ACCA55500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACCA55500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1664.0, "discounted_cash": 998.4, "setting": "both", "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, 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{"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 1320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TRANSITIONAL 3.5 - 6.0 X 400MM OS2123", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS2123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD UNEUM COER 120MM TI", "code_information": [{"code": "14-524947", "type": "CDM"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ZAVATION 5.5 X 40MM STRAIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-5450-M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ZAVATION 5.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C040-M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 714.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RODS 80MM MB1RL5580", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB1RL5580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RODS CURVED 80MM SF5080TC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SF5080TC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3800.0, "discounted_cash": 2280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RODS LORDOTIC 120MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GS0161-1120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1243.2, "discounted_cash": 745.92, "setting": "both", "billing_class": "facility"}]}, {"description": "ROOM/BED: Inpatient Private", "code_information": [{"code": "1363822", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 2072.0, "discounted_cash": 1243.2, "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": 109.2, "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": 17.86, "discounted_cash": 10.72, "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": 35.9, "discounted_cash": 21.54, "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": 21.62, "discounted_cash": 12.97, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE COMBO INJECTION 100ML", "code_information": [{"code": "MED0596", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 149.96, "discounted_cash": 89.98, "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": 289.51, "discounted_cash": 173.71, "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": 453.05, "discounted_cash": 271.83, "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": 29.13, "discounted_cash": 17.48, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.79, "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": "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": 88.24, "discounted_cash": 52.94, "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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 8450.0, "methodology": "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", "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": 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": 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": 0.51, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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 WHOLE HEALTH", "standard_charge_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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 0.51, "methodology": "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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1952.0, "methodology": "fee 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": 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": 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", "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": 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": 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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", "standard_charge_dollar": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 5077.0, "methodology": "fee 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": 9735.0, "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": 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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 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": 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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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 HERN PREEMIE REDUC", "code_information": [{"code": "49491", "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": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "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": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "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": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "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": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "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": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "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": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "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": "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": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "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": "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": 37.99, "discounted_cash": 22.79, "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": 4620.0, "methodology": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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 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[{"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"}, {"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": 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"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"}, {"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", 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"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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, 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"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", 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"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": "S-ROD EXTENDED TIP LRG", "code_information": [{"code": "14-589094", "type": "CDM"}], "standard_charges": [{"gross_charge": 4760.0, "discounted_cash": 2856.0, "setting": "both", "billing_class": "facility"}]}, {"description": "S-ROD EXTENDED TIP SML", "code_information": [{"code": "14-589093", "type": "CDM"}], 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 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 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": 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": 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", "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", "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3208.0, "discounted_cash": 1924.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SALVATION BOLT 5.0 X 75MM SB005075", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB005075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3208.0, "discounted_cash": 1924.8, "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": "SANDSHARK INJECTABLE ANCHOR KIT", "code_information": [{"code": "SHRK-ALL-1K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 843.0, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 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"methodology": "fee 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": 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 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"standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 9MM OSCILLATING", "code_information": [{"code": "OSB-9S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.6, "discounted_cash": 273.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE OSTEOTOMY", "code_information": [{"code": "80-0740-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.4, "discounted_cash": 168.84, "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": 89.08, "discounted_cash": 53.45, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_dollar": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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 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{"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 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 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 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{"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 SURGICAL SZ 15 BARD-PARKER", "code_information": [{"code": "371615", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.42, "discounted_cash": 2.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", 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[{"gross_charge": 3780.0, "discounted_cash": 2268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCEW POLYAXIAL 5.5MM X 40MM 5500 SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55055-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3780.0, "discounted_cash": 2268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCEW POLYAXIAL 6.5MM X 35MM 5500 SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55065-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3780.0, "discounted_cash": 2268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCHLEIN POSITIONING KITS", "code_information": [{"code": "NON081647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.81, "discounted_cash": 53.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR ENDO .5IN X 35 CM 5 MM CURVEDINSTR DISP", "code_information": [{"code": "ES0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.54, "discounted_cash": 63.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR FIBERWIRE AR-11796", "code_information": [{"code": "AR-11796", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.06, "discounted_cash": 319.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR WIRE CUTTING 5IN DISP", "code_information": [{"code": "HS8153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 15.0, "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": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1603.0, "discounted_cash": 961.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCOPE INTRAVU 90MM IV-ASY-1090", "code_information": [{"code": "IV-ASY-1090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1374.0, "discounted_cash": 824.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCOPE WARMER SURGICAL JOSNOE", "code_information": [{"code": "PS-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.54, "discounted_cash": 19.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SCORPION NEEDLE STERILE", "code_information": [{"code": "AR-1399ON", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.42, "discounted_cash": 276.25, "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": 8400.0, "discounted_cash": 5040.0, "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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee 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": 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": 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 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": "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": 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"methodology": "fee schedule"}, {"payer_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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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, 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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": 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schedule"}], "billing_class": "facility"}]}, {"description": "SELF-PUNCHING TRIPLE LOADED FIBERTAK AR-3633SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3633SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 888.88, "discounted_cash": 533.33, "setting": "both", "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 39.53, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.79, "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": 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 ADHSV RESPIRATORY MONITORING OXISENSOR PEDI DISP", "code_information": [{"code": "D20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "discounted_cash": 26.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR FOREHEAD ADHESIVE MAXFAST", "code_information": [{"code": "MAXFAST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.41, "discounted_cash": 54.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR INFANT OXIMAX MAXI", "code_information": [{"code": "MAXI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.34, "discounted_cash": 29.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR LNCS PEDIATRIC MAXP", "code_information": [{"code": "MAXP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.95, "discounted_cash": 22.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR MONITOR BRAIN BIS QUATRO 25BX 186-0106", "code_information": [{"code": "186-0106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.06, "discounted_cash": 46.24, "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": 71.3, "discounted_cash": 42.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR O2 ADHSV OXIMAX OXISENSOR II LF STRL PEDI DISP", "code_information": [{"code": "I-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.06, "discounted_cash": 28.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR OXIMETER FINGER ADLT", "code_information": [{"code": "D25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "discounted_cash": 26.84, "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": 3.34, "discounted_cash": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR SPO2 ADLT", "code_information": [{"code": "MAXA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.95, "discounted_cash": 22.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR SPO2 MASIMO LNCS", "code_information": [{"code": "LNCS ADTX-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.15, "discounted_cash": 30.69, "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", "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": 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 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": "SENZA 2 TEMPLATE", "code_information": [{"code": "ACCK7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.25, "discounted_cash": 150.75, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": 8312.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": "SERFAS ENERGY 90-S CRUISE", "code_information": [{"code": "279-401-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.09, "discounted_cash": 266.45, "setting": "both", "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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "SERIES A ASYMMETRIC PAT 25X8 184790", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A ASYMMETRIC PAT 28X8 184791", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A ASYMMETRIC PAT 31X8 184792", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A ASYMMETRIC PAT 34X8.5 184793", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "184793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.3, "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": "SERVICE PROFESSIONAL POST OP", "code_information": [{"code": "SMI-OFPS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.5, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SESAMOIDECTOMY THUMB OR FINGER 26185", "code_information": [{"code": "26185", "type": "CPT"}, {"code": "45462618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 998.0, "maximum": 8450.0, "gross_charge": 2062.0, "discounted_cash": 1237.2, "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": 998.0, "methodology": "fee schedule"}, {"payer_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": "SESAMOIDECTOMY-FIRST TOE 28315", "code_information": [{"code": "28315", "type": "CPT"}, {"code": "1482093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET 10MM SINGLE USE INSTRUMENT MTS-10", "code_information": [{"code": "MTS-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SET 5500 SERIES SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55635-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET 5500SERIES MIS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77635-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "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": 18.69, "discounted_cash": 11.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 110IN TUBING SOLN GRAVITY 10 DROPS PER ML DRIP RATE DRIP CHMBR MALE LU", "code_information": [{"code": "2C6537", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.63, "discounted_cash": 11.18, "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": 14.09, "discounted_cash": 8.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 92IN 10 DROPS PER ML MALE LUER LOCK ADAPTERINTERLINK BASIC VENTED W/ D", "code_information": [{"code": "2C6419", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 11.56, "discounted_cash": 6.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ANESTHESIA 73IN 1.7 ML NONPYROGENIC LUER LOCK ADAPTER STRL", "code_information": [{"code": "2C9216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.73, "discounted_cash": 7.04, "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": 24.67, "discounted_cash": 14.8, "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": 398.65, "discounted_cash": 239.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLADE HOOK TRIANGLE STRL DISP-1", "code_information": [{"code": "3056-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.29, "discounted_cash": 291.17, "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": 4.37, "discounted_cash": 2.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLD PUMP Y-TYPE CRSITE 170MIC 490105", "code_information": [{"code": "490105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 21.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOCK SZ F5 T5 CUTTING PATIENT MATCHED LFT VISIONAIRE", "code_information": [{"code": "V0100022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2748.0, "discounted_cash": 1648.8, "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": 31.08, "discounted_cash": 18.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD ADMINISTRATION Y TYPE 10 DROPS ML 84 BMGNF5140", "code_information": [{"code": "BMGNF5140", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.59, "discounted_cash": 18.35, "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": 7.36, "discounted_cash": 4.42, "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": 3.33, "discounted_cash": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CANNULA LUER 2.9MM GRADUATED FLOW PORT SHORT STERILE", "code_information": [{"code": "3781", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.59, "discounted_cash": 236.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CAP 15MM BONE VAULT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-1002-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CAP 93110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "93110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CARESITE SMALLBORE EXT 470100", "code_information": [{"code": "470100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.79, "discounted_cash": 7.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CATH 0.9 ML 7.6IN EXT NON DEHP CLEARLINK LUER ACTIVATED VALVE MALE LUER LOX", "code_information": [{"code": "2N8378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.9, "discounted_cash": 6.54, "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": 351.05, "discounted_cash": 210.63, "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": 4.14, "discounted_cash": 2.48, "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": 7.36, "discounted_cash": 4.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CNULA 4.5MM BLUE CONICAL TIP DIST HOLE THRD W/ CANNULA AND OBTURATOR W/ SEAL", "code_information": [{"code": "4615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.4, "discounted_cash": 37.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CNULA 5.5MM 70MM GRAY CONICAL TIP DIST HOLE THRD W/ CANNULA AND OBTURATOR W/", "code_information": [{"code": "4616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.23, "discounted_cash": 54.74, "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": 4809.0, "discounted_cash": 2885.4, "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": 414.16, "discounted_cash": 248.5, "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": 913.25, "discounted_cash": 547.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT 2.6 ML 86IN PCAINTRAVENOUS W/INTEGRAL PAV ANDINJECTOR ASSEMBLY", "code_information": [{"code": "14279-28", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 30.88, "discounted_cash": 18.53, "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": 46.17, "discounted_cash": 27.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT W LUER LOCK ADAPTER 21 53CM 2C6226", "code_information": [{"code": "2C6226", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.05, "discounted_cash": 1.83, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION .9ML 6IN IV LL STD BOR SPNLK CARESITE VLV", "code_information": [{"code": "470109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.1, "discounted_cash": 6.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION 4.3ML 96IN MICROBORE FEMALE ADAPTER W/ ATTACHED PAV", "code_information": [{"code": "1426828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.05, "discounted_cash": 32.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSIONINTERLINK SYS", "code_information": [{"code": "2C6631", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.17, "discounted_cash": 5.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENTIION CATHETER MICROBONEONELINK 470124", "code_information": [{"code": "470124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.1, "discounted_cash": 6.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENTION 21IN 3.4 ML PRIMING VOLUME 2 PORT MALE LUER LOCK ADAPTER WITHOUT F", "code_information": [{"code": "2C8606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.75, "discounted_cash": 259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET GUIDE KNEE FOR MRI OR CT SCAN SIGNATURE", "code_information": [{"code": "42-422551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1781.16, "discounted_cash": 1068.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HANDPIECE W/ COAXIAL HIGH FLOW SUCTION TIPINTERPULSEINSTR", "code_information": [{"code": "210-114-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.83, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HANDPIECEINTERPULSE W/ 10FT SUCTION TUBE", "code_information": [{"code": "210100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.18, "discounted_cash": 49.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFUSION 20G X .75IN Y INJECTION SITE WINGED SAFETY MINILOC", "code_information": [{"code": "682034", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 29.33, "discounted_cash": 17.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFUSION 20G X .75IN Y INJECTION SITE WINGED SAFETY MINILOC", "code_information": [{"code": "682034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.89, "discounted_cash": 30.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFUSION SMARTSITE", "code_information": [{"code": "72013E", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 17.67, "discounted_cash": 10.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFUSOMAT LUER 22 DROP/ML 115IN", "code_information": [{"code": "BMG490100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.01, "discounted_cash": 22.81, "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": 668.78, "discounted_cash": 401.27, "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": 39.39, "discounted_cash": 23.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRR 81IN Y TYPE TRANSURETHRAL RESECTION LNG BORE TUBING FOR USE W/ UROMATIC", "code_information": [{"code": "2C4005", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 39.41, "discounted_cash": 23.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRR 96IN ARTHROSCOPIC 2 LEAD FOR USE W/ ARTHROMATIC PLASTIC CONTAINERS LF ST", "code_information": [{"code": "2C4030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.42, "discounted_cash": 18.25, "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": 55.32, "discounted_cash": 33.19, "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": 52.5, "discounted_cash": 31.5, "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": 11.62, "discounted_cash": 6.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV ADMIN 15 DROP WITH 3 CARE SITE", "code_information": [{"code": "354205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.54, "discounted_cash": 11.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXT TUBING 0.02 X 60IN MICROBORE FEMALE DISTAL MALE LL", "code_information": [{"code": "V6222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.31, "discounted_cash": 6.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION FILTER 10 INCH", "code_information": [{"code": "473994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.3, "discounted_cash": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV SECONDARY 40IN SPIN-LOCK CONN BAG HANGER", "code_information": [{"code": "264-9145-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.13, "discounted_cash": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SET K-WIRE FOR INTECH", "code_information": [{"code": "LB-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 337.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET LOCKING CAP SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET MED 37IN SECONDARY 10 DROPS/ML DRIP RATE MALE LUER LOCK CONNECTOR FOR USE W/", "code_information": [{"code": "2C7461", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.74, "discounted_cash": 2.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NEEDLE 4INCH NERVE BLOCK 360 ECHO TUOHY ULTRA", "code_information": [{"code": "331641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.78, "discounted_cash": 68.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 18GA X 2ININSULATED TUHOY NDL CONTINUOUS NON STIMULATING CATH ON", "code_information": [{"code": "331691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.71, "discounted_cash": 52.03, "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": 80.9, "discounted_cash": 48.54, "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": 79.38, "discounted_cash": 47.63, "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": 1701.47, "discounted_cash": 1020.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SET OATS SM 8MM OSETOCHONDRAL AUTO GRAFT TRANSFER SYS STRL DISP", "code_information": [{"code": "AR-8981-08S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1621.32, "discounted_cash": 972.79, "setting": "both", "billing_class": "facility"}]}, {"description": "SET OPAT QUICK CONNECT PROCESSING", "code_information": [{"code": "OPT-P-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 985.33, "discounted_cash": 591.2, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 RESUSCITATOR MANUAL WITH SOFT CUSHION MASK TEXTURED NON SLIP GRIP BAG MASK AND RED UNIVERSAL O2", "code_information": [{"code": "CPRM1126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.45, "discounted_cash": 37.47, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RESUSCITATOR MANUAL WITH SOFT CUSHION MASK TEXTURED NON SLIP GRIP BAG MASK AND RED UNIVERSAL O2", "code_information": [{"code": "CPRM2216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.72, "discounted_cash": 29.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 1.5MM X 9MM THORACIC LUMBAR NON STRL OPTIMA IMP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 30 HEXALOBE SS", "code_information": [{"code": "5006400", "type": "CDM"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 166.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 5-7MM PEDICLE SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-50101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 5.5MM BREAK OFF NON STRL TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5540030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-80100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 340.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 90 DEGREE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NLSS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 501.96, "discounted_cash": 301.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW CAP LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FS100T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW CAPSURE CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Nov-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "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": 960.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW HEXALOBE 30 GOLD TI", "code_information": [{"code": "94950", "type": "CDM"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 166.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW ILLIAC SPLINED", "code_information": [{"code": "5006780", "type": "CDM"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW IMP SVANNAH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-07 (AMENDIA)", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1160.0, "discounted_cash": 696.0, "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": 698.0, "discounted_cash": 418.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW LANX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7902-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW LOCKING CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MBINS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW LOCKING CAP MBILS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MBILS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW LOCKING SCREW/ROD CONNECTION MB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB2LS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 684.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW MIS", "code_information": [{"code": "77634-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW MIS SET SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABBA00000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 418.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW NP1500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NP1500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2640.0, "discounted_cash": 1584.0, "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": 698.0, "discounted_cash": 418.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW SPINAL FXTN ORTHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7703-1600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW SPINE 5.5 PEDICLE ANYPLUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GS0104-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW SPINEFRONTIER 5-7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-80101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 445.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW SPLINED", "code_information": [{"code": "5005660", "type": "CDM"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW STANDARD ZODIAC TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "22015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 644.0, "discounted_cash": 386.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW SURG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "39-LS-0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 318.0, "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": 150.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35635-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREWS 0954-0002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "954-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 340.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREWS DB110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREWS LOCKING CAP ROD SECURMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MS1L100T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SIGNATURE HIP GUIDE CUSTOM ALIGNMENT GDE/MDL", "code_information": [{"code": "42-100400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2519.0, "discounted_cash": 1511.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOL BLOOD Y TYPEINTERLINK", "code_information": [{"code": "2C6714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.2, "discounted_cash": 13.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLN 10 DROPS PER ML 112IN CLEARLINK LUER ACTIVATED VALVES MALE LUER LOCK AD", "code_information": [{"code": "2C8519", "type": "CDM"}, {"code": "258", 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MICROBOREINTEGRAL PAV W/ YELLOW STRIPED TUBING GE", "code_information": [{"code": "1374428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.14, "discounted_cash": 33.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STD EXT W SPIN-LOCK CONNECTION 6 470108", "code_information": [{"code": "470108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.1, "discounted_cash": 6.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STRAP ARM FOR ARC WRIST TOWER 24/36IN", "code_information": [{"code": "10170060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SUTURE ARTHROSCOPY TFCC MENDER TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR", "code_information": [{"code": "7210752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.83, "discounted_cash": 248.9, "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": 952.59, "discounted_cash": 571.55, "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": 95.85, "discounted_cash": 57.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE INSUFFLATION AIRSEAL IFS TRI LUMEN FILTERED AIRSEAL MODE", "code_information": [{"code": "ASM-EVAC1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.09, "discounted_cash": 158.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE IRRIGATION FOR MISONIX", "code_information": [{"code": "MXB-T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE POWERED DISSECTOR", "code_information": [{"code": "7033-8003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.1, "discounted_cash": 89.46, "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": 98.3, "discounted_cash": 58.98, "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": 198.22, "discounted_cash": 118.93, "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 BLOOD STANDARD FLOW W/ EXTENSION SET RANGER DISP", "code_information": [{"code": "24250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.36, "discounted_cash": 32.02, "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": 441.68, "discounted_cash": 265.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINSTR KNOT PUSHER CUTTER CURVED W/ SLOTTED CANNULA FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.48, "discounted_cash": 163.49, "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": 1190.8, "discounted_cash": 714.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINSTR PIN AND DRILL GENESIS", "code_information": [{"code": "114968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.29, "discounted_cash": 276.17, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVERING ADHESIONS OF ANTERIOR SYNECHIAE OF 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"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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.33, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 828.95, "discounted_cash": 497.37, "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": 744.65, "discounted_cash": 446.79, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT REAMER", "code_information": [{"code": "227-8510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.13, "discounted_cash": 789.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT REAMER 448MM MODIFIED TRINKLE BIXCUT", "code_information": [{"code": "227-3000S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1152.56, "discounted_cash": 691.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 1.6MM MANUAL HPSINSTR", "code_information": [{"code": "320-1116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.79, "discounted_cash": 235.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.4MM MANUAL HPSINSTR", "code_information": [{"code": "320-1124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.79, "discounted_cash": 235.67, "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": 244.05, "discounted_cash": 146.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.5MM HEXAGONAL CANNULATED", "code_information": [{"code": "314.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.77, "discounted_cash": 585.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2MM MANUAL HPSINSTR", "code_information": [{"code": "320-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.79, "discounted_cash": 235.67, "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": 132.0, "discounted_cash": 79.2, "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": 87.88, "discounted_cash": 52.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SHARP HOOK AR-8943-21", "code_information": [{"code": "AR-8943-21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.5, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SHARPS KIT 1500-5060", "code_information": [{"code": "1500-5060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 674.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "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 0.5 CM/<", "code_information": [{"code": "11310", "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": "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": "11307", "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": "11308", "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": "SHAVER 3.4 MM STANDARD R-10012", "code_information": [{"code": "R-10012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 85.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 3IN1 KNEE SCOPE R-10008", "code_information": [{"code": "R-10008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.65, "discounted_cash": 446.79, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER ANGLED AGG. PLUS BLADE F SERIES 4", "code_information": [{"code": "380544100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.07, "discounted_cash": 82.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER ARTHROSCOPY STANDARD CURVED 3.4MM R-10024", "code_information": [{"code": "R-10024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 85.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER DIAMON 4.4MM AND TUBESET 110-31-1230", "code_information": [{"code": "110-31-1230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1271.18, "discounted_cash": 762.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER DIEGO 4MM 40DEG", "code_information": [{"code": "70138008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.1, "discounted_cash": 89.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICRO HOOK MIS SHEATH AND TUBESET 110-31-2210", "code_information": [{"code": "110-31-2210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1729.36, "discounted_cash": 1037.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICRO HOOK WITH TIP EXTENTION AND SLEEVE", "code_information": [{"code": "MXB-S1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1193.69, "discounted_cash": 716.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVERDRILL 2.9 SHORT PUSHLOCK", "code_information": [{"code": "AR-2923DSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.25, "discounted_cash": 190.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL/ DERMAL LESION-SCALP-NECK-HANDS-FEET-GENITALIA 0.5CM OR LESS 11305", 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"plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.6, "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": 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"discounted_cash": 41.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM DISPOSABLE", "code_information": [{"code": "6310-001", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM INTECH 70MM X 15MM RETRACTOR", "code_information": [{"code": "6210-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.5, "discounted_cash": 590.1, "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": 25.47, "discounted_cash": 15.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI SKID", "code_information": [{"code": "2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI-SKID", "code_information": [{"code": "2852", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.1, "discounted_cash": 0.06, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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{"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": "SILVER NITRATE APPLICATORS", "code_information": [{"code": "MED0184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER SULFADIAZINE CREAM/SILVADENE", "code_information": [{"code": "MED0185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.41, "discounted_cash": 27.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 30ML DROPS MYLOCON", "code_information": [{"code": "MED0186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.68, "discounted_cash": 5.81, "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", 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2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 537.24, "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 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": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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", 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 537.24, "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": "SIMPLE REPAIR WOUNDS 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"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": "SIMPLIFY\u00c2\u00ae CERVICAL ARTIFICIAL DISC SIZE MD HEIGHT 6 MD-6", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "MD-6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 7440.0, "setting": "both", "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, 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"plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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 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SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "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": 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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 1027.53, "methodology": "fee schedule"}, {"payer_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 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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 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 F/N/HF/G ADDL", "code_information": [{"code": "15276", "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": 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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, "estimated_discounted_cash": 6380.88, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "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": 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": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 COMPR SM THIGH LEN COMPRESSION SYS TUBING SCD EXPRESS LF", "code_information": [{"code": "9545 (Sleeve)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.84, "discounted_cash": 83.3, "setting": "both", "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": 3.88, "discounted_cash": 2.33, "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": 272.85, "discounted_cash": 163.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE GAMMA FINDER PROBE LF PROTECTIVE", "code_information": [{"code": "GMSLV00110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.27, "discounted_cash": 33.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE GOWN 23IN FLUID RESISTANT W/ CSR WRAP ECLIPSE LF STRL", "code_information": [{"code": "DYNJP2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.55, "discounted_cash": 2.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LEGION HK 18MM BOLT - 71421388", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1191.36, "discounted_cash": 714.82, "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 NAIL INSERTION ELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1806-1406S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 100.8, "setting": "both", "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 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XCEL 5MMX100MM CB5LT", "code_information": [{"code": "CB5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.55, "discounted_cash": 44.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STERILE", "code_information": [{"code": "599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.91, "discounted_cash": 2.35, "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": 590.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TAPER 12 BY 14 48MM MODULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71344249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 496.12, "discounted_cash": 297.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TRAY 37MM POROUS MBT M L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129454100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6385.4, "discounted_cash": 3831.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TRAY POROUS MBT M L 37MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1294-54-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6385.4, "discounted_cash": 3831.24, "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": 79.11, "discounted_cash": 47.47, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE WIRE 1.6MMINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "323.023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 592.21, "discounted_cash": 355.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIDER NEEDLE 25 DEG LEFT 3910-500-754", "code_information": [{"code": "3910-500-754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.85, "discounted_cash": 311.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIDER NEEDLE 45 DEG LEFT 3910-500-752", "code_information": [{"code": "3910-500-752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.85, "discounted_cash": 311.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIDER NEEDLE 60DEG STRAIGHT 3910-500-758", "code_information": [{"code": "3910-500-758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.85, "discounted_cash": 311.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIM Y PLATE 2 SHAFT HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2051.92, "discounted_cash": 1231.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM DEEP POCKET NECK PAD MED", "code_information": [{"code": "ORT11300M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.32, "discounted_cash": 14.59, "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": 13.57, "discounted_cash": 8.14, "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": 13.57, "discounted_cash": 8.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM PEDIATRIC PRINT CHILD", "code_information": [{"code": "ORT11400S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.04, "discounted_cash": 16.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM PEDIATRIC PRINT INFANT", "code_information": [{"code": "ORT11400XXS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.04, "discounted_cash": 16.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM PEDIATRIC PRINT TODDLER", "code_information": [{"code": "ORT11400XS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.04, "discounted_cash": 16.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM STANDARD LRG", "code_information": [{"code": "ORT11100L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.59, "discounted_cash": 11.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM STANDARD MED", "code_information": [{"code": "ORT11100M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.47, "discounted_cash": 9.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM STANDARD SML", "code_information": [{"code": "ORT11100S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.02, "discounted_cash": 9.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM STANDARD XL", "code_information": [{"code": "ORT11100XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.02, "discounted_cash": 9.01, "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": 7698.0, "discounted_cash": 4618.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 3725.83, "methodology": "fee schedule"}, {"payer_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": 2279.15, "maximum": 9357.0, "gross_charge": 4709.0, "discounted_cash": 2825.4, "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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 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"plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": 2061.68, "discounted_cash": 1237.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLINGSHOT 70DEG UP", "code_information": [{"code": "CAT02590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 882.62, "discounted_cash": 529.57, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "SLOTTED HEAD CRADLE FOAM POSITIONER", "code_information": [{"code": "FP-HEADSL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.39, "discounted_cash": 9.83, "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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 2985.18, "discounted_cash": 1791.11, "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.94, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 2989.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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/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": 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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL COVER PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL INTESTINAL ENDOSCOPY; ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM; INCL ILEUM 44378", "code_information": [{"code": "44378", "type": "CPT"}, {"code": "44786941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL SOCKET INSERT 32MM NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-02-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TRICORTICAL BLOCK OP101020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OP101020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4080.0, "discounted_cash": 2448.0, "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 TIPS 1X55MM 155", "code_information": [{"code": "STT0413-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 674.4, "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": 2111.4, "discounted_cash": 1266.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SMARTGOWN BREATH IMPERV LARGE 89015", "code_information": [{"code": "89015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.48, "discounted_cash": 10.49, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.27, "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 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"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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "SMITH & NEPHEW CAP PRICE SGSH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TKI-VERILAST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13873.8, "discounted_cash": 8324.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SMITH & NEPHEW CAP SGSH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TKI-LEGION", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9515.86, "discounted_cash": 5709.52, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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 EVACUATOR PENCIL NEPTUNE", "code_information": [{"code": "703-046-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.1, "discounted_cash": 46.86, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 58.75, "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 ELECTROSURGICAL 20MM X 230CM SPIRAL", "code_information": [{"code": "SD-230U-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.41, "discounted_cash": 42.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE LESION-HUNTER COLD 10MM CS50051", "code_information": [{"code": "CS50051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.96, "discounted_cash": 40.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE LESION-HUNTER COLD 15MM CS50061", "code_information": [{"code": "CS50061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.96, "discounted_cash": 40.18, "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": 59.89, "discounted_cash": 35.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE POLYECTOMY 240 CM X 33MM 2.4MM ROUND ENDO PSA M00561290", "code_information": [{"code": "M00561291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.75, "discounted_cash": 41.85, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.23, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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{"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 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": 0.51, "methodology": "fee 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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee 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19.02, "discounted_cash": 11.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE IRRIGATION SOLUTION 500 ML BOTTLE ABB613803", "code_information": [{"code": "ABB613803", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.02, "discounted_cash": 11.41, "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": 121.1, "discounted_cash": 72.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFNOLIME CO2 ABSORBER SO077", "code_information": [{"code": "SO077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.85, "discounted_cash": 35.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [{"code": "501", "type": 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"code_information": [{"code": "14-531166", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 14MM X 12MM X 8MM", "code_information": [{"code": "14-531168", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 14MM X 12MM X 9MM", "code_information": [{"code": "14-531169", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 14MM X 12MM X7MM", "code_information": [{"code": "14-531167", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 10MM", "code_information": [{"code": "14-531380", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 11MM", "code_information": [{"code": "14-531381", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 12MM", "code_information": [{"code": "14-531382", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 5MM", "code_information": [{"code": "14-531375", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 6MM", "code_information": [{"code": "14-531376", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 7MM", "code_information": [{"code": "14-531377", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 8MM", "code_information": [{"code": "14-531378", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 16MM X 14MM X 9MM", "code_information": [{"code": "14-531379", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 10MM", "code_information": [{"code": "14-531180", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 11MM", "code_information": [{"code": "14-531181", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 5MM", "code_information": [{"code": "14-531175", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 6MM", "code_information": [{"code": "14-531176", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 7MM", "code_information": [{"code": "14-531177", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 8MM", "code_information": [{"code": "14-531178", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MM X 16MM X 9MM", "code_information": [{"code": "14-531179", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PARALLEL 18MMX 16MM X 12MM", "code_information": [{"code": "14-531182", "type": "CDM"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 2494.8, "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": 7200.0, "discounted_cash": 4320.0, "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": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SMALL 8MM WITH SCREW 533-08-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "533-08-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "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": 7200.0, "discounted_cash": 4320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 12MM LG 7DEG LUMBAR LORDOTIC NOVEL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PTT-LCCS-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 2880.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 12MM MED 12DEG LUMBAR LORDOTIC SOLUS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25200-312-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 14MM LG 12DEG LUMBAR LORDOTIC SOLUS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25600-314-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 14MM MED 12DEG LUMBAR LORDOTIC SOLUS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25200-314-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12500.0, "discounted_cash": 7500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 14MM X 16MM X 7MM 7DEG LOW PROFILE COALITION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "384.307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14840.0, "discounted_cash": 8904.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL LG 15DEG 13MM LOW PROFILEINDEPENDENCE 26 X 34", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "376.513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33666.0, "discounted_cash": 20199.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL LG 15DEG 13MM LOW PROFILEINDEPENDENCE 29 X 39", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "376.813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33666.0, "discounted_cash": 20199.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE 20 X 55 X 9MM 6DEG TRANSCONTINENTAL PEEK RAD POLY SD LORDOTIC LUMBAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375.479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22320.0, "discounted_cash": 13392.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE 6 X 22 X 50MM 20DEG COROENT ROUND XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6200650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12284.0, "discounted_cash": 7370.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE 6 X 22 X 55MM 20DEG COROENT ROUND XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6200655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12284.0, "discounted_cash": 7370.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE INTERLAMINAR STABILIZATION COFLEX F SYSTEM 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RPI00012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10740.0, "discounted_cash": 6444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TLIF 12MM SM LUMBAR MIS PORTAL PEEK SIGNATURE", "code_information": [{"code": "14-523080", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TLIF 17MM SM LUMBAR MIS PORTAL PEEK SIGNATURE", "code_information": [{"code": "14-524370", "type": "CDM"}], "standard_charges": [{"gross_charge": 4694.0, "discounted_cash": 2816.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TLIF 8 X 18 X 50MM 10 DEGREE 101-08185010-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-08185010-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8132.4, "discounted_cash": 4879.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERT 7MM MED CONVEX NRW THORACOLUMBAR VETEBRAL BODY REPLACE DEV SUSTAIN", "code_information": [{"code": "2000-7535", "type": "CDM"}], "standard_charges": [{"gross_charge": 5142.0, "discounted_cash": 3085.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERT 9MM LG ANTEROLATERAL THORACOLUMBAR VETEBRAL BODY REPLACE DEV SUSTAIN", "code_information": [{"code": "14-578240", "type": "CDM"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEC EF PRIM HO 12/14 SZ 4 71312114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71312114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6545.0, "discounted_cash": 3927.0, "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", 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[{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "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": 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": 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", "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": 8450.0, "methodology": "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": 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": 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": 4620.0, "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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 100 COTTON CAST PADING 6X4YD 9086", "code_information": [{"code": "9086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.2, "discounted_cash": 3.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECIALIST 100 COTTON CAST PADING 9083", "code_information": [{"code": "9083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.45, "discounted_cash": 2.07, "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 4 OZ STERILE CUP SPC400", "code_information": [{"code": "SPC400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.35, "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 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": "SPECTRA WAVEWRITER IMPLANTABLE PULSE GENERATOR KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC1160 KIT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34600.0, "discounted_cash": 20760.0, "setting": "both", "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.79, "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": "SPECTRUM QC SZ 3 GLIDESCOPE 0270-1083", "code_information": [{"code": "270-1083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.55, "discounted_cash": 87.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECTRUM QC SZ4 GLIDESCOPE 0270-1084", "code_information": [{"code": "270-1084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.55, "discounted_cash": 87.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM SIGMOIDOSCOPE DISPSBL NORET 53130", "code_information": [{"code": "53130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.8, "discounted_cash": 8.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL LG PREMIUM KLEENSPECINSTR DISP", "code_information": [{"code": "59004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.25, "discounted_cash": 5.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL MEDIUM DISPOSABLE 59001", "code_information": [{"code": "59001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.25, "discounted_cash": 4.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL SM PREMIUM 590 SERIES KLEENSPECINSTR DISP", "code_information": [{"code": "59000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "discounted_cash": 4.43, "setting": "both", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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": 1130.0, "discounted_cash": 678.0, "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": 2113.8, "discounted_cash": 1268.28, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.48, "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.23, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "SPHERE 5 TRAY 12PK 8801075", "code_information": [{"code": "8801075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 247.87, "discounted_cash": 148.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE MICRO 500TO 700UM 2.0 ML RED SYRNG DEL SYS 20ML NORMAL SALINE EMBOSPHERE", "code_information": [{"code": "S620H", "type": "CDM"}], "standard_charges": [{"gross_charge": 1037.76, "discounted_cash": 622.66, "setting": "both", "billing_class": "facility"}]}, {"description": 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schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE 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 KYPHOPLASTY CAP PRICE KYPHO CAP PRICE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KYPHO CAP PRICE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90000.0, "discounted_cash": 54000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINECAP PRICING SPINECAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SPINECAP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 4800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINPLUS 6X16MM RSP0616MFSZ", "code_information": [{"code": "RSP0616MFSZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4465.5, "discounted_cash": 2679.3, "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": 9.03, "discounted_cash": 5.42, "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": 10.7, "discounted_cash": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER VOLUME INCENTIVE 4000ML 001902A", "code_information": [{"code": "1902A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.39, "discounted_cash": 6.83, "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": 10.7, "discounted_cash": 6.42, "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": 42.1, "discounted_cash": 25.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERS VYAIRE AIRLIFE VOLUMETRIC INCENTIVE BXT001901A", "code_information": [{"code": "BXT001901A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.27, "discounted_cash": 6.76, "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": 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": 0.51, "methodology": "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": 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": 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": "SPLENECTOMY; TOTAL 38100", "code_information": [{"code": "38100", "type": "CPT"}, {"code": "44626511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2046.33, "maximum": 8450.0, "gross_charge": 6201.0, "discounted_cash": 3720.6, "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": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3001.28, "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": 2046.33, "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": "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 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1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DSSCTR .38IN SURG OBJECT DETECTION CHERRY ROUND X RAY DETECT STRL", "code_information": [{"code": "1757H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE ENDOZYME DRY INDV. 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1.8, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN WHT TWELVE PLY CURITY LF STRL", "code_information": [{"code": "6939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.39, "discounted_cash": 2.03, "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": 214.16, "discounted_cash": 128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GELFOAM SZ 50", "code_information": [{"code": "P9032301P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.4, "discounted_cash": 38.04, "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": 61.28, "discounted_cash": 36.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GUAZE WOVEN 4X4 12 PLY NS C-NSG4412E", "code_information": [{"code": "C-NSG4412E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE IMP COMPRESSIBILE SM TALL", "code_information": [{"code": "3-0836434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3088.0, "discounted_cash": 1852.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE INDUX CANCELLOUS 1.414 X 14MM", "code_information": [{"code": "45-3214", "type": "CDM"}], "standard_charges": [{"gross_charge": 2536.0, "discounted_cash": 1521.6, "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": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAPAROTOMY 18IN X 18IN X RAY DETECT COTTON WITHOUT RING STRL", "code_information": [{"code": "23250-400A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 14.61, "discounted_cash": 8.77, "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": 15.7, "discounted_cash": 9.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTONOID 0.5IN X 1.0IN", "code_information": [{"code": "NEUROSPNG06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.2, "discounted_cash": 8.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PATTIE .5IN X 3IN WHT SURG RECTANGLE COTTON STRL", "code_information": [{"code": "CO 801407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.54, "discounted_cash": 2.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PEANUT XRAY .375IN", "code_information": [{"code": "MDS72038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.17, "discounted_cash": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE ROUND DISSECTOR C-5 HOLDER 5'S ST", "code_information": [{"code": "10563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.8, "discounted_cash": 8.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SUPER FLUFF 6IN X 6.75IN", "code_information": [{"code": "C-SUS662S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SURG 1/2IN X 1/2IN WHT NEURO 1 STRING RAYON STRL", "code_information": [{"code": "30-054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.25, "discounted_cash": 3.15, "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": 28.91, "discounted_cash": 17.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL", "code_information": [{"code": "10604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL 1IN DOUBLE STRUNG XRAY DETECTABLE STERILE", "code_information": [{"code": "10606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.75, "discounted_cash": 31.05, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL 2-STRING STERILE MEDIUM 5/PK COTTON", "code_information": [{"code": "ACMAOSDX50BI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 3.45, "discounted_cash": 2.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL LG 2 STRING STRL", "code_information": [{"code": "ACMAOSDLLX50BI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL SMALL DOUBLE STRONG X RAY DETECTABLE", "code_information": [{"code": "78912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE WICK 9.0 X 24.0CM MEROCEL POPE EAR", "code_information": [{"code": "400146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.09, "discounted_cash": 16.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGES GAUZE STANDARD 2INX2IN 8PLY", "code_information": [{"code": "C-NSG228E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": "SPOT X EX", "code_information": [{"code": "GIS-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.48, "discounted_cash": 73.49, "setting": "both", "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": 15612.28, "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": 56.52, "discounted_cash": 33.91, "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": 56.52, "discounted_cash": 33.91, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.85, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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 CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 8450.0, "methodology": "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": 13239.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": "SS FIXED SCREW 75MM X 30MM", "code_information": [{"code": "5006596", "type": "CDM"}], "standard_charges": [{"gross_charge": 2644.0, "discounted_cash": 1586.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SS FIXED SCREW 75MM X 35MM", 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[{"gross_charge": 2644.0, "discounted_cash": 1586.4, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 WALLSTENT 16 X 60 40332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "40332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5186.0, "discounted_cash": 3111.6, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 2123.0, "discounted_cash": 1273.8, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1027.53, "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": 2258.0, "discounted_cash": 1354.8, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1092.87, "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", "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", "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": 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": "STERIFUSE DBM EVOLVED 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "32605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 3240.0, "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": 3377.75, "discounted_cash": 2026.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE NEEDLE 6CM 11GA J-TYPE 12001211", "code_information": [{"code": "12001211", "type": "CDM"}], "standard_charges": [{"gross_charge": 127.8, "discounted_cash": 76.68, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER AQUAPAK FOR INHALATION 340 ML W/ 040 HUMIDIFIER ADAPTOR RHP340U", "code_information": [{"code": "RHP340U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.04, "discounted_cash": 3.62, "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": 20.66, "discounted_cash": 12.4, "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": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 5ML", "code_information": [{"code": "MED0192", "type": "CDM"}], "standard_charges": [{"gross_charge": 13.13, "discounted_cash": 7.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER SOLUTION", "code_information": [{"code": "RDI30295", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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 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"plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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[{"gross_charge": 452.25, "discounted_cash": 271.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMUBLAST GEL 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2002-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.22, "discounted_cash": 475.33, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", 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"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", 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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{"description": "STIMULATOR PC HANDSET COMMUNICATOR TH91SCSR", "code_information": [{"code": "TH91SCSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR PROCLAIM 5 3661", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42000.0, "discounted_cash": 25200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR RECHARGE CHARGING KIT RS7230", "code_information": [{"code": "RS7230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 30.76, "discounted_cash": 18.46, "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": 18.0, "discounted_cash": 10.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE PROTOUCH SYNTHETIC 4X25YD 30 1004", "code_information": [{"code": "30-1004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.73, "discounted_cash": 31.64, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE SINGLE PLY 4X48 STERILE", "code_information": [{"code": "NON22360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.99, "discounted_cash": 4.79, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE TUBULAR 12IN X 48IN IMPERVIOUS STRL", 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"STOCKING ANTI EMBOLISM MED REG WHT KNEE LEN OPENINSPECTION TOE NYLON SPANDEX TED", "code_information": [{"code": "7115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.84, "discounted_cash": 6.5, "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": 24.73, "discounted_cash": 14.84, "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": 36.1, "discounted_cash": 21.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM SM LNG THIGH LEN COMPR TED HOSE W/ BELT T.E.D LF", 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{"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH XL REG LF", "code_information": [{"code": "MDS160684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.7, "discounted_cash": 12.42, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM LG REG THIGH LEN DBM GRADUATED COMPRESSION", "code_information": [{"code": "3728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.99, "discounted_cash": 12.59, "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": 20.99, "discounted_cash": 12.59, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTIEMBOLISM EXTRA XL LNG KNEE CAP T.E.D. 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"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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "STOPCOCK IV 3 WAY LUER LOCK ADAPTER STANDARD BORE LF STRL", "code_information": [{"code": "2C6240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.68, "discounted_cash": 2.81, "setting": "both", "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STOPCOCK: 3-WAY STOPCOCK WITH HANDLE IN OFF POSITION", "code_information": [{"code": "DYNJSC301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "STPLER SKIN PROXIMATE PLUS MD REG 35 PMR35", "code_information": [{"code": "PMR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.77, "discounted_cash": 15.46, "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": 242.25, "discounted_cash": 145.35, "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": 140.09, "discounted_cash": 84.05, "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": 231.68, "discounted_cash": 139.01, "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": 231.68, "discounted_cash": 139.01, "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": 81.05, "discounted_cash": 48.63, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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 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"standard_charge_dollar": 1519.76, "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": "STRABISMUS SURGERY 1 VERTICAL MUSCLE 67314", "code_information": [{"code": "67314", "type": "CPT"}, {"code": "1482149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAIGHT PASSER DISPOSABLE CERCLAGE AR-7821", "code_information": [{"code": "AR-7821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 685.36, "discounted_cash": 411.22, "setting": "both", "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": 2853.5, "discounted_cash": 1712.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAND GRACILIS SINGLE NON BONE TENDON FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "44322002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2239.2, "discounted_cash": 1343.52, "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": 1390.11, "discounted_cash": 834.07, "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": 216.08, "discounted_cash": 129.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP BITE BLOCK PEDIATRIC", "code_information": [{"code": "BX00712808", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.64, "discounted_cash": 9.38, "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": 1.8, "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 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"standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPS HEAD ANESTHESIA HEAD STRAP DYNJAASTRAP", "code_information": [{"code": "DYNJAASTRAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.83, "discounted_cash": 16.7, "setting": "both", "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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 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"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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.46, "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 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0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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[{"gross_charge": 2792.7, "discounted_cash": 1675.62, "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": 38.55, "discounted_cash": 23.13, "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": 58.88, "discounted_cash": 35.33, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPONGE 36MM X 19MM X 6MM DBM", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "L2PTTDBMSS35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP WOUND CLOSURE 0.5IN X 4IN REINFORCED", "code_information": [{"code": "1047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.21, "discounted_cash": 2.53, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPPER VEIN DISP", "code_information": [{"code": "63-4031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.57, "discounted_cash": 64.54, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPS EPISEAL WOUND CLOSURE 46-216-1", "code_information": [{"code": "46-216-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.75, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPS PLATFORM CM 1 X 12.5 X 0.4CM 10CC", "code_information": [{"code": "CM46410", "type": "CDM"}], "standard_charges": [{"gross_charge": 4778.0, "discounted_cash": 2866.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPS PLATFORM CM 1 X 12.5 X 0.4CM 20CC", "code_information": [{"code": "CM46420", "type": "CDM"}], "standard_charges": [{"gross_charge": 8820.0, "discounted_cash": 5292.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPS PLATFORM CM 1 X 12.5 X 0.4CM 5CC", "code_information": [{"code": "CM4640S", "type": "CDM"}], "standard_charges": [{"gross_charge": 3412.0, "discounted_cash": 2047.2, "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": "STRUT ENCLAVE 12IN X 10MM", "code_information": [{"code": "14-530450", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 12IN X 12MM", "code_information": [{"code": "14-530452", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 12IN X 14MM", "code_information": [{"code": "14-530454", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 12IN X 16MM", "code_information": [{"code": "14-530456", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 12IN X 18MM", "code_information": [{"code": "14-530458", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 12IN X 20MM", "code_information": [{"code": "14-530460", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 10MM", "code_information": [{"code": "14-530430", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 12MM", "code_information": [{"code": "14-530432", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 14MM", "code_information": [{"code": "14-530434", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 16MM", "code_information": [{"code": "14-530436", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 18MM", "code_information": [{"code": "14-530438", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT ENCLAVE 6IN X 20MM", "code_information": [{"code": "14-530440", "type": "CDM"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT SHORT LENGTH 119-161 MM TELES 4933-0-120", "code_information": [{"code": "4933-0-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2672.43, "discounted_cash": 1603.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT STATIC 60MM LNG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.94, "discounted_cash": 114.56, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT TELESCOPIC 100-125MM HOFFMAN EXTRA SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-0-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2334.0, "discounted_cash": 1400.4, "setting": "both", "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": 141.74, "discounted_cash": 85.04, "setting": "both", "billing_class": "facility"}]}, {"description": "STUD FXTN 8.5 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P085-0017-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.0, "discounted_cash": 793.2, "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": 8.73, "discounted_cash": 5.24, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATION 14FR LUBRICATED", "code_information": [{"code": "251014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.37, "discounted_cash": 5.62, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET KIT 70CM", "code_information": [{"code": "ACCK8012-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLETINTUBATING 10FR", "code_information": [{"code": "85864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.48, "discounted_cash": 5.69, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLETINTUBATING 6FR", "code_information": [{"code": "85863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.68, "discounted_cash": 5.21, "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": 4580.0, "discounted_cash": 2748.0, "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": 2977.0, "discounted_cash": 1786.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS VIVAER CAT723", "code_information": [{"code": "CAT723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBCUTANEOUS INJECTION OF FILLING MATERIAL 1.1 TO 5.0CC 11951", "code_information": [{"code": "11951", "type": "CPT"}, {"code": "16066205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 613.12, "discounted_cash": 367.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 296.75, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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 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"standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 5538.0, "discounted_cash": 3322.8, "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": 2698.44, "discounted_cash": 1619.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE GRAFT 15.8 ML 1MM TO 2MM BONE MOLDABLE ACTIFUSE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "5.06005E+11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5940.0, "discounted_cash": 3564.0, "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": 4532.0, "discounted_cash": 2719.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE GRAFT BONE FOAM VITOSS IMP", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "2102-2201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1404.8, "discounted_cash": 842.88, "setting": "both", "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 5/6FR CONTROL COIL", "code_information": [{"code": "T63C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION PROBE + 50-S SWEEP 3.5MM X 135MM 0279-351-650", "code_information": [{"code": "279-351-650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.09, "discounted_cash": 318.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TUBE ASSORTMENT - FCS 3-12 (FOR BARON FRAZIER & FUKUSHIMA BR-4999", "code_information": [{"code": "BR-4999", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.03, "discounted_cash": 19.22, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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"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": "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": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"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": 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, 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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 PROCEDURE KIT NANOSCOPIC RELEASE SYSTEM AR-8850DS", "code_information": [{"code": "AR-8850DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1820.55, "discounted_cash": 1092.33, "setting": "both", "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": "SURGICEL 2X14N OXIDIZED CELLULOSE", "code_information": [{"code": "MED0575", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 385.78, "discounted_cash": 231.47, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL 2X3", "code_information": [{"code": "MED0520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.71, "discounted_cash": 142.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL 3X4", "code_information": [{"code": "MED0584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.14, "discounted_cash": 114.68, "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": 452.03, "discounted_cash": 271.22, "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": 5.98, "discounted_cash": 3.59, "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": 297.55, "discounted_cash": 178.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO", "code_information": [{"code": "MED0196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.5, "discounted_cash": 287.1, "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": 437.32, "discounted_cash": 262.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM 8X12.5CMX10MM SPONGE", "code_information": [{"code": "MED0197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.91, "discounted_cash": 52.15, "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": 207.7, "discounted_cash": 124.62, "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": 472.36, "discounted_cash": 283.42, "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 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"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 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION SULFATE 1900 ML BARIUM LIQ POLIBAR PLUS", "code_information": [{"code": "256643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.13, "discounted_cash": 33.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUSPENSION SULFATE 600ML ENTERO VU BARIUM SM BOWEL ENTEROCLYSIS LIQUID", "code_information": [{"code": "403704", 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"discounted_cash": 7.82, "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": 15.88, "discounted_cash": 9.53, "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": 7.78, "discounted_cash": 4.67, "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": 7.64, "discounted_cash": 4.58, "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": 24.23, "discounted_cash": 14.54, "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": 7.07, "discounted_cash": 4.24, "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": 7.17, "discounted_cash": 4.3, "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": 7.5, "discounted_cash": 4.5, "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": 7.31, "discounted_cash": 4.39, "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": 7.19, "discounted_cash": 4.31, "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": 8.89, "discounted_cash": 5.33, "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": 9.12, "discounted_cash": 5.47, "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": 28.71, "discounted_cash": 17.23, "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": 8.5, "discounted_cash": 5.1, "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": 9.61, "discounted_cash": 5.77, "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": 10.52, "discounted_cash": 6.31, "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": 11.01, "discounted_cash": 6.61, "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": 11.75, "discounted_cash": 7.05, "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": 8.17, "discounted_cash": 4.9, "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": 11.87, "discounted_cash": 7.12, "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": 31.21, "discounted_cash": 18.73, "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": 13.49, "discounted_cash": 8.09, "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": 8.29, "discounted_cash": 4.97, "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": 8.14, "discounted_cash": 4.88, "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": 7.6, "discounted_cash": 4.56, "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": 10.96, "discounted_cash": 6.58, "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": 11.84, "discounted_cash": 7.1, "setting": 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[{"gross_charge": 254.2, "discounted_cash": 152.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE FIBERTAK WITH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.0, "discounted_cash": 609.6, "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": 417.61, "discounted_cash": 250.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE TIGERLOOP 1.3MM WH/BL.", "code_information": [{"code": "AR-7535T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.67, "discounted_cash": 185.2, "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": 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"AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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-PLATE 2.4MM 8 HOLE REINFORCED AR-18724P-44", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18724P-44", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1723.56, "discounted_cash": 1034.14, "setting": "both", "billing_class": "facility"}]}, {"description": "T-PLATE 4 HOLE COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-152-0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1995.0, "discounted_cash": 1197.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-PLATE 5-HOLE W/ COMPRESSION P53-152-0002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-152-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1995.0, "discounted_cash": 1197.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-PLIF 9X27X0DEG -10 100-092700-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092700-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-PLIF 9X27X5DEG -10 100-092705-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092705-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22000.0, "discounted_cash": 13200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T3 Free", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "633834", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 234.0, "discounted_cash": 140.4, "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": 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", "standard_charge_dollar": 86.9, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 295.0, "discounted_cash": 177.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 109.56, "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": 244.89, "discounted_cash": 146.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TABLE OVERBED 30IN X 15IN H BASE COMPOSITE TOP HOLDS UP TO 50 POUNDS LF", "code_information": [{"code": "MDS107015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TABLETS BARIUM EZ DISC", "code_information": [{"code": "778", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.22, "discounted_cash": 2.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TABS PATIENT TRACKER 8000-100-001", "code_information": [{"code": "8000-100-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 269.24, "discounted_cash": 161.54, "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": 57.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TACK PLATE SM LOCKING RADIAL HEADINSTRINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "80-0248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 56.4, "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": "TAG WRITE-ON PINK MISSING WT-1911", "code_information": [{"code": "WT-1911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "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 BB LRG ANKLE FUSION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-8970-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 231.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAK BB THREADED LRG ANKLE FUSION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-8970-09T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 180.0, "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": 184.28, "discounted_cash": 110.57, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 3.5MM", "code_information": [{"code": "1200-9019", "type": "CDM"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 387.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.9MM OMEGA 3910-947-205", "code_information": [{"code": "3910-947-205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1699.18, "discounted_cash": 1019.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.0MM", "code_information": [{"code": "1200-9020", "type": "CDM"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 387.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.5MM", "code_information": [{"code": "1200-9022", "type": "CDM"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 387.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 6.5MM 804-03-018", "code_information": [{"code": "804-03-018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 301.5, "discounted_cash": 180.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 6.5MM CANNULATED", "code_information": [{"code": "5601-6500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.95, "discounted_cash": 235.17, "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": 442.2, "discounted_cash": 265.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 3.5 MM", "code_information": [{"code": "14-S10020", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 4.0 MM", "code_information": [{"code": "14-S10021", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 4.5 MM", "code_information": [{"code": "14-S10022", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 5.0 MM", "code_information": [{"code": "14-510023", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 5.5 MM", "code_information": [{"code": "14-S10024", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 6.0 MM", "code_information": [{"code": "14-S1002S", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BIOMET 6.5 MM", "code_information": [{"code": "14-510026", "type": "CDM"}], "standard_charges": [{"gross_charge": 3435.0, "discounted_cash": 2061.0, "setting": "both", "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": 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CAROLINA JONES CANNULATED SS", "code_information": [{"code": "5601-5500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.35, "discounted_cash": 243.21, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BONE CANNULATED 5MM 705254", "code_information": [{"code": "705254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1216.53, "discounted_cash": 729.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED FOR 4.5 MM CANNULATED SCREW", "code_information": [{"code": "311.59", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1392.97, "discounted_cash": 835.78, "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": 1267.52, "discounted_cash": 760.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED SCREW 4.5MM SS", "code_information": [{"code": "56014500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.4, "discounted_cash": 289.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP DRILL 2.8MM", "code_information": [{"code": "HR-D105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.54, "discounted_cash": 65.12, "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": 431.68, "discounted_cash": 259.01, "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": 472.35, "discounted_cash": 283.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW FOR 6.5 MM CANCELLOUS BONE SCREW", "code_information": [{"code": "311.66", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 799.44, "discounted_cash": 479.66, "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": 472.35, "discounted_cash": 283.41, "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": 32.6, "discounted_cash": 19.56, "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": 19.5, "discounted_cash": 11.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE EMERGENCY BROSELOW PEDI", "code_information": [{"code": "AE-4800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.3, "discounted_cash": 55.38, "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": 9.26, "discounted_cash": 5.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE SUTURE XBRAID TT 1.4MM WHITE/BLACK 3910-900-003", "code_information": [{"code": "3910-900-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 60.0, "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": 181.57, "discounted_cash": 108.94, "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": 10.81, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 1/8IN X 18IN 2 STRANDS PER PACKET COTTON STRL", "code_information": [{"code": "U10T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.86, "discounted_cash": 3.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 1/8X36 3 STRANDS U12T", "code_information": [{"code": "U12T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.58, "discounted_cash": 5.15, "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": 6.31, "discounted_cash": 3.79, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPER ADAPTOR 0MM STANDARD NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1330.15.270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 648.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPER ADAPTOR MINI 9 (USE WITH MINIBASEPLATE 25MM) 118000", "code_information": [{"code": "118000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPOCCIPITAL", "code_information": [{"code": "1200-9104", "type": "CDM"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 248.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TARGETING DELIVERY SYS ACCUPORT KNEE CREATIONS", "code_information": [{"code": "307.034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1166.12, "discounted_cash": 699.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TARGETING NDL BEVEL TIP 11G", "code_information": [{"code": "79702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 201.0, "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": 3200.0, "discounted_cash": 1920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_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": 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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": "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": 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 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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "UHC", "standard_charge_dollar": 8312.0, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": "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": "TEARS LUBRICATING OINTMENT 3.5 GM", "code_information": [{"code": "MED0518", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.7, "discounted_cash": 6.42, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 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", "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 134.0, "discounted_cash": 80.4, "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": 128.0, "discounted_cash": 76.8, "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": "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": "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 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": 3660.38, "discounted_cash": 2196.23, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON DOUBLE STRAND", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DST-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 2412.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON GRAFT FROM A DISTANCE 20924", "code_information": [{"code": "20924", "type": "CPT"}, {"code": "1582386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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 FLEXOR PALM OPEN EACH TENDON 26450", "code_information": [{"code": "26450", "type": "CPT"}, 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"standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1299.05, "methodology": "fee schedule"}, {"payer_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 HIP ABDUCTOR/EXTENSOR 27006", 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{"description": "TENOTOMY HIP FLEXOR(S)-OPEN 27005", "code_information": [{"code": "27005", "type": "CPT"}, {"code": "1482214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1857.24, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.84, "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": 81.08, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST STRIP KIT COAG-SENSE", "code_information": [{"code": "COAG-03P50-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST STRIP REVITAL OX 2BTL RESERT R60 SOLUTION", "code_information": [{"code": "PCC054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.14, "discounted_cash": 5.48, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.06, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.7, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.59, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.69, "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": 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": "TETATNUS & DIPHTHERIA TOXIDS, 7 YRS OR OLDER", "code_information": [{"code": "90714", "type": "CPT"}, {"code": "3355712", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 44.0, "discounted_cash": 26.4, "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": "TETRACAINE 0.5% 2ML OPHTHALMIC DROPS/PONTOCAINE", "code_information": [{"code": "MED0199", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.6, "discounted_cash": 14.16, "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": 63.61, "discounted_cash": 38.17, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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", "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": 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", "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 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{"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. 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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": 152.0, "discounted_cash": 91.2, "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": 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": 152.0, "discounted_cash": 91.2, "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": 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 PROPHYLACTIC OR DIAGNOSTIC INJ. intra-arterial 96373", "code_information": [{"code": "96373", "type": "CPT"}, {"code": "42627454", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 84.23, "maximum": 8450.0, "gross_charge": 150.0, "discounted_cash": 90.0, "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": 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": "THERAPEUTIC PROPHYLACTIC./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "42624978", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 174.81, "maximum": 8450.0, "gross_charge": 155.0, "discounted_cash": 93.0, "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": 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 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": "THIN OSTEO BLADE 10 X 5 71369410", "code_information": [{"code": "71369410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.62, "discounted_cash": 195.37, "setting": "both", "billing_class": "facility"}]}, {"description": "THIN OSTEO BLADE 20 X 3 71369220", "code_information": [{"code": "71369220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.29, "discounted_cash": 155.57, "setting": "both", "billing_class": "facility"}]}, {"description": "THIN OSTEO BLD ROUND END 12MM 71369412", "code_information": [{"code": "71369412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.62, "discounted_cash": 195.37, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 9357.0, "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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "THREE-SPRING EVACUATOR KITS 43610", "code_information": [{"code": "43610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.57, "discounted_cash": 24.94, "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": 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": "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", "standard_charge_dollar": 1301.0, "methodology": "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 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.71, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.56, "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": 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": 153.65, "discounted_cash": 92.19, "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 2827.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.56, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.89, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "standard_charge_dollar": 4620.0, "methodology": "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": 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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "standard_charge_dollar": 8450.0, "methodology": "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": 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": 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": 1952.0, "methodology": "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": 1952.0, "methodology": "fee schedule"}, {"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": 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": 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 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": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "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": "THYROIDECTOMY TOTAL OR COMPLETE 60240", "code_information": [{"code": "60240", "type": "CPT"}, {"code": "1482238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2723.95, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 9735.0, "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": "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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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": 2723.95, "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": "TI CERVICAL SPINE LOCKING PL VARIABLE ANGLE 3 LEVEL/51MM 450.173", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "450.173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 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INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIP BLADE 1/3MM TO 18MM ACCUVISION DISP", "code_information": [{"code": "14-500550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1148.0, "discounted_cash": 688.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BLADE 1/4 TO 25MM FLAT ACCUVISION", "code_information": [{"code": "14-500551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1148.0, "discounted_cash": 688.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BLADE 18MM ILLUMINATED ACCUVISION", "code_information": [{"code": "14-500555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1402.0, "discounted_cash": 841.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BLADE 25MM ACCUVISION", "code_information": [{"code": "14-500552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1148.0, "discounted_cash": 688.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BLADE 25MM ILLUMINATED ACCUVISION", "code_information": [{"code": "14-500557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1402.0, "discounted_cash": 841.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BONE CLEANING", "code_information": [{"code": "210-010-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.75, "discounted_cash": 27.45, "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": 40.25, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP DRIVER 1.5MM HEX SM SHAFT FOR ACU LOCK DIST RADIUS PLATE", "code_information": [{"code": "HPC-0015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.48, "discounted_cash": 323.09, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ELECTROCAUTERY REG EXTENDED 6IN BLADE TYPE COATED", "code_information": [{"code": "E1450-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.91, "discounted_cash": 10.75, "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": 595.38, "discounted_cash": 357.23, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP INSERTER 6MM MED SPINAL STRL", "code_information": [{"code": "3.820.131S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11450.0, "discounted_cash": 6870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP INSERTER F LARGE 6MM", "code_information": [{"code": "3.820.134S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6870.0, "discounted_cash": 4122.0, "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": 41.52, "discounted_cash": 24.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION 22CM PULSAVAC PLUS HIGH CAPACITY", "code_information": [{"code": "515018400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.71, "discounted_cash": 79.03, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP MIXER W/ SPRAY TIP", "code_information": [{"code": "ATM100TIP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.5, "discounted_cash": 106.5, "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": 83.67, "discounted_cash": 50.2, "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": 159.32, "discounted_cash": 95.59, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SOLID LOCK HEX 3.5MM", "code_information": [{"code": "2810-01-019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.07, "discounted_cash": 106.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCT 10FR FRAZIER NON CONDUCTIVE HANDLE REMOVABLE PLASTIC OBTURATOR ARGYLE L", "code_information": [{"code": "166025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.04, "discounted_cash": 5.42, "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": 3.12, "discounted_cash": 1.87, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION SIGMOIDAL STERILE 18FR", "code_information": [{"code": "33050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.92, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPINSERTER 5MM LG SPINAL STRL", "code_information": [{"code": "3.820.133S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3091.5, "discounted_cash": 1854.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPINSERTER 5MM MED SPINAL STRL", "code_information": [{"code": "3.820.130S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11450.0, "discounted_cash": 6870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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 2ML", "code_information": [{"code": "MED0203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.66, "discounted_cash": 191.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL 4ML", "code_information": [{"code": "MED0204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.23, "discounted_cash": 264.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL PRE-FILLED PRIMA SYRINGE 2ML 1506078", "code_information": [{"code": "C9250", "type": "HCPCS"}, {"code": "1506078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 179.26, "discounted_cash": 107.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE CULTURE BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 227.26, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 227.65, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "TISSUE EXPANDER DERMACLOSE XL", "code_information": [{"code": "204020-K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2974.71, "discounted_cash": 1784.83, "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": 2123.0, "discounted_cash": 1273.8, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 HUMAN CARTILAGE LIVE 00-5606-000-30", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "-5606-000-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10560.0, "discounted_cash": 6336.0, "setting": "both", "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": 4612.0, "discounted_cash": 2767.2, "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": 6800.0, "discounted_cash": 4080.0, "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 RELEASE SMARTRELEASE ENDOSCOPIC SOFT 83030", "code_information": [{"code": "83030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 927.3, "discounted_cash": 556.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE SEALER ENSEAL X1 CURVED 37CM SHAFT NSLX137C", "code_information": [{"code": "NSLX137C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.07, "discounted_cash": 798.64, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE SEALER ENSEAL X1 STRAIGHT 37CM SHAFT NSLX137S", "code_information": [{"code": "NSLX137S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1156.62, "discounted_cash": 693.97, "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": 4000.0, "discounted_cash": 2400.0, "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": 3525.0, "discounted_cash": 2115.0, "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 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 11473.0, "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": "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": 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": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "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": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 11473.0, "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": "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": 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": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "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": "TLIF 30 6DEG -08 101-3008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-3008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9990.0, "discounted_cash": 5994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TLIF 30 6DEG -09 101-3009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-3009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9990.0, "discounted_cash": 5994.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TLIF 30 6DEG -10 101-3010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-3010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9990.0, "discounted_cash": 5994.0, "setting": "both", "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": 538.71, "discounted_cash": 323.23, "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": 143.07, "discounted_cash": 85.84, "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": 49.25, "discounted_cash": 29.55, "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": 214.57, "discounted_cash": 128.74, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 80 MG / 2 ML VIAL", "code_information": [{"code": "MED0375", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.62, "discounted_cash": 6.37, "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 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "TOGA FLYTE 2XL SURGICOOL ZIPPERED PEELAWAY", "code_information": [{"code": "408-841-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.1, "discounted_cash": 141.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURGICAL TOTALSHIELD ZIPPERED LARGE AAMI LEVEL 3", "code_information": [{"code": "990031110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.43, "discounted_cash": 92.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURGICAL TOTALSHIELD ZIPPERED REGULAR AAMI LEVEL 3", "code_information": [{"code": "990031010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.43, "discounted_cash": 92.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURGICAL TOTALSHIELD ZIPPERED X-LARGE AAMI LEVEL 3", "code_information": [{"code": "990031210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.43, "discounted_cash": 92.66, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"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. 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2046.35, "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": "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": 3001.76, "maximum": 9735.0, "gross_charge": 6202.0, "discounted_cash": 3721.2, "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": 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": 3001.76, "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": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY LUMBAR ANTERIOR APPROACH 22857", "code_information": [{"code": "22857", "type": "CPT"}, {"code": "1482254", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1395.24, "maximum": 14796.0, "gross_charge": 4228.0, "discounted_cash": 2536.8, "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": 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": 2046.35, "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": 1395.24, "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 HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE POLY XE LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M5725060XE10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17762.0, "discounted_cash": 10657.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL KNEE UPCHARGE OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TKU-OXINIUM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4185.56, "discounted_cash": 2511.34, "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": 6000.0, "discounted_cash": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER CAP PRICE FLEX REVERSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TRSF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20000.0, "discounted_cash": 12000.0, "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": 7698.0, "discounted_cash": 4618.8, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": "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": 3725.83, "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 STABILIZER+ TIBIAL INSERT 5537-G-422-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-422-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9378.0, "discounted_cash": 5626.8, "setting": "both", "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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "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": 5628.0, "discounted_cash": 3376.8, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "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": "TOURNIQUET 18 X 4 DISP SINGLE PORT RED", "code_information": [{"code": "5921-218-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.78, "discounted_cash": 37.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 18IN REPROCESS W/ PLC DUAL PORT DUAL BLADDER STRL DISP", "code_information": [{"code": "607080102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 24IN DUAL PORT SNGL BLADDER REPROCESS WITHOUT SLEEVE STRL DISP", "code_information": [{"code": "607070104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.52, "discounted_cash": 36.91, "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": 48.96, "discounted_cash": 29.38, "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": 48.96, "discounted_cash": 29.38, "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": 48.96, "discounted_cash": 29.38, "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": 56.66, "discounted_cash": 34.0, "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": 48.96, "discounted_cash": 29.38, "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": 48.96, "discounted_cash": 29.38, "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": 47.34, "discounted_cash": 28.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 34IN REPROCESS DISP", "code_information": [{"code": "60-7070-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.44, "discounted_cash": 44.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 42 DUAL PORT ZIM0707010700", "code_information": [{"code": "ZIM0707010700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.45, "discounted_cash": 36.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CYLINDRICAL 12IN X 2IN SNGL BLADDER DUAL PORT QUICK CONNECT", "code_information": [{"code": "5921-112-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.22, "discounted_cash": 77.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CYLINDRICAL 44IN X 4IN NAVY BLUE SNGL BLADDER W/ 40IN TUBING COLOR CU", "code_information": [{"code": "5921-044-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.78, "discounted_cash": 37.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DISPOSABLE 30X4 ROYALBLUE 5921-030-135", "code_information": [{"code": "5921-030-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.78, "discounted_cash": 37.67, "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": 44.85, "discounted_cash": 26.91, "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": 60.45, "discounted_cash": 36.27, "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": 1.8, "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": 48.96, "discounted_cash": 29.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET PNEUMATIC LG GRN FINGER RING SILICONE TOURNI COT DISP", "code_information": [{"code": "TCL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.63, "discounted_cash": 14.18, "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": 22.08, "discounted_cash": 13.25, "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": 80.99, "discounted_cash": 48.59, "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": 9.22, "discounted_cash": 5.53, "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": 1.8, "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": 5.06, "discounted_cash": 3.04, "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": 9.32, "discounted_cash": 5.59, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL STERILE 18 X 26 3520", "code_information": [{"code": "3520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 14.32, "discounted_cash": 8.59, "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": 1.8, "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": 3.95, "discounted_cash": 2.37, "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": 4.77, "discounted_cash": 2.86, "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": 10.7, "discounted_cash": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL STERILE DISPOSABLE DELUXE OR BLUE 17 X 27IN MDT2168204", "code_information": [{"code": "MDT2168204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWELS OR BLUE MDT2168284 MDT2168284", "code_information": [{"code": "MDT2168284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "discounted_cash": 5.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWER STRAPS/FINGER TRAPS ARC WRIST TOWER CHARGE", "code_information": [{"code": "75-0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1338.75, "discounted_cash": 803.25, "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 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.23, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 QUICK 4MM", "code_information": [{"code": "120900040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 626.1, "discounted_cash": 375.66, "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": 4172.0, "discounted_cash": 2503.2, "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": 2019.24, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": "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": "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 ELECTROMAGNETIC 8000-040-001", "code_information": [{"code": "8000-040-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6315.75, "discounted_cash": 3789.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 1GM/100ML NS", "code_information": [{"code": "MED0592", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.6, "discounted_cash": 33.96, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 5892.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.71, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.71, "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 CRANIAL NERVE; EXTRADURAL 64771", "code_information": [{"code": "64771", "type": "CPT"}, {"code": "45399517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": 1027.53, "methodology": "fee schedule"}, {"payer_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": "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": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 1273.8, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "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": 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": "TRANSECTION OR AVULSION; FACIAL NERVE 64742", "code_information": [{"code": "64742", "type": "CPT"}, {"code": "30902891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1028.5, "maximum": 8450.0, "gross_charge": 2125.0, "discounted_cash": 1275.0, "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": 1028.5, "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": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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"standard_charge_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": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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"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": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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 OF TENDON CARPOMETACARPAL OR DORSUM HAND W/FREE TENDON GRAFT EA. 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1519.76, "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": 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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": 5628.0, "discounted_cash": 3376.8, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2723.95, "methodology": "fee schedule"}, {"payer_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 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{"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2723.95, "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "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": 2723.95, "maximum": 9735.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "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": 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", "standard_charge_dollar": 2723.95, "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": 9735.0, "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": 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": "TRANSPLANT OR TRANSFER THIGH SINGLE TENDON 27396", "code_information": [{"code": "27396", "type": "CPT"}, {"code": "46225800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9537.0, "discounted_cash": 5722.2, "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": 4615.9, "methodology": "fee schedule"}, {"payer_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 PREP OF HEMATOPOIETIC PROGENITOR CELLS CONC. IN PLASMA MONONUCLEAR 38215", "code_information": [{"code": "38215", "type": "CPT"}, {"code": "8675629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": "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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": "UHC", "standard_charge_dollar": 9357.0, "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": "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 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"methodology": "fee schedule"}, {"payer_name": "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": 1519.76, "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": "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 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[{"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 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"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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "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": 1519.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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{"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": "TRANSVERSE ABDOMINIS PLANE BLOCK UNILATERAL BY INJECTION 64486", "code_information": [{"code": "64486", "type": "CPT"}, {"code": "39346917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3048.0, "discounted_cash": 1828.8, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1475.23, "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": "TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK BILATERAL; CONTINUOUS INFUSION 64489", "code_information": [{"code": "64489", "type": "CPT"}, {"code": "44645880", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1211.0, "discounted_cash": 726.6, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": "TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK; BILATERAL 64488", "code_information": [{"code": "64488", "type": "CPT"}, {"code": "42918208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4010.0, "discounted_cash": 2406.0, "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE 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": 1940.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "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 SMALL", "code_information": [{"code": "9906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.11, "discounted_cash": 32.47, "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": 59.72, "discounted_cash": 35.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP FINGER MED ORTHO", "code_information": [{"code": "10170052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP FINGER MED WRIST FOR ARTHROSCOPIC SURGERY STRL", "code_information": [{"code": "AR-1616-M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 406.19, "discounted_cash": 243.71, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP SPECIMEN ENVIRON MATE", "code_information": [{"code": "PT20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.44, "discounted_cash": 6.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP STERILE MUCUS SPECIMEN 40CC 24EA/CS", "code_information": [{"code": "K1023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "discounted_cash": 2.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP WATER DRYLINE ADLT/PEDI", "code_information": [{"code": "9200-10-10530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.73, "discounted_cash": 45.44, "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": 483.0, "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 54MM X 50MM HUMERAL 8RT0-5450-A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8RT0-5450-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY AIRWAY 30 FR ROBERTAZZINASOPHARYNGEAL DYNJNASO30", "code_information": [{"code": "DYNJNASO30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.77, "discounted_cash": 16.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY AIRWAY 32FR NASOPHARYNGEAL DYNJNASO32", "code_information": [{"code": "DYNJNASO32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.77, "discounted_cash": 16.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY ANGIOGRAPHIC II W/ DEPOSIT BAG DISPOSAL DEPOT", "code_information": [{"code": "K10T-03784", "type": "CDM"}], "standard_charges": [{"gross_charge": 207.7, "discounted_cash": 124.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY ARTHROGRAM 18GA 20GA 25GA LUER LOCK SYRNG STRL DISP", "code_information": [{"code": "408501", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.33, "discounted_cash": 51.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BEAD CERAMENT A0513", "code_information": [{"code": "A0513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.5, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BLOCK PAIN ST", "code_information": [{"code": "89-4064-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.77, "discounted_cash": 21.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BLOCK UNIVERSAL NO MEDS MEDLINE PAIN9013S", "code_information": [{"code": "PAIN9013S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.63, "discounted_cash": 27.98, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATH 14FR URETHRAL VINYL", "code_information": [{"code": "DYND10300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.18, "discounted_cash": 7.31, "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": 97.27, "discounted_cash": 58.36, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATHIZATION 15FR URETHRAL RED RUBBER", "code_information": [{"code": "DYNC1816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.88, "discounted_cash": 7.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CENTRAL LINE DRESSING CHANGE DYND75229", "code_information": [{"code": "DYND75229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.01, "discounted_cash": 29.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CRUCIATE 63MM FINNED TIBL COBALT CHROME ASCENT MAXIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY DRSG CENTRAL LINE DRESSING CHANGE TRAY MINOR PROCEDURE TRAY W/ CHLORAPREP L", "code_information": [{"code": "DYND75221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.83, "discounted_cash": 10.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPI 18GA X 3.5IN TUOHY NDL CLOSED TIP CATH 20GA CONTINUOUS FULL W/ 25GA X 1", "code_information": [{"code": "332211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.44, "discounted_cash": 50.66, "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": 52.19, "discounted_cash": 31.31, "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": 5372.86, "discounted_cash": 3223.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FIRST FRACTURE 15/3 OSTEOINTRODUCER SYS W/ KYPHON XPANDER KYPHOPAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KPT1502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6846.0, "discounted_cash": 4107.6, "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": 35.88, "discounted_cash": 21.53, "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": 72.87, "discounted_cash": 43.72, "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": 35.88, "discounted_cash": 21.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY HUMERAL 44MM +5 COBALT CHROME W/ LOCK RING COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "115375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3200.0, "discounted_cash": 1920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY HUMERAL 46 X 42MM 8RT0-4642-A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8RT0-4642-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY KWIRE RACK HOLDS 6 DIA 4 TO 6 INCH KI71RACK46", "code_information": [{"code": "KI71RACK46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 809.28, "discounted_cash": 485.57, "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": 6461.28, "discounted_cash": 3876.77, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LACERATION ER ACS-S-LAC4", "code_information": [{"code": "ACS-S-LAC4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.31, "discounted_cash": 10.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LACERATION PRESOURCE LF", "code_information": [{"code": "ACS-S-LAC-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.06, "discounted_cash": 13.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LACERATION STRL", "code_information": [{"code": "DYNJ03000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.78, "discounted_cash": 3.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LACERATION SUTURING W/ COMPARTMENT TRAY 6 GAUZE 4IN X 4IN 1 TOWEL 1 FENESTR", "code_information": [{"code": "DYNJ03009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.15, "discounted_cash": 14.49, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PAIN DISPOSABLE SINGLE USE", "code_information": [{"code": "34-9846B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.95, "discounted_cash": 32.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PAIN DISPOSABLE/SINGLE USE", "code_information": [{"code": "34-9846A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.88, "discounted_cash": 21.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PREPARATION DRY SKIN PREMIUM TRAY SKIN SCRUB W/ 1 PAIR VINYL GLVS LF STRL", "code_information": [{"code": "DYND70661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.56, "discounted_cash": 6.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PREPARATION WET PREMIUM SKIN TRAY SKIN SCRUB W/ 1 PAIR VINYL GLVS STRL", "code_information": [{"code": "DYND70360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.96, "discounted_cash": 14.98, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PROCEDURAL UROLOGIST CONTAINS ALL COMPONENTS NEEDED FOR DILATION AND CATHER", "code_information": [{"code": "123400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.15, "discounted_cash": 256.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PUNCTURE 3.5IN X 20GA FOR LUMBAR PUNCTURE", "code_information": [{"code": "4301C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.89, "discounted_cash": 27.53, "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": 2925.0, "discounted_cash": 1755.0, "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": 23.4, "discounted_cash": 14.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPNL 25GA X 3.5IN ANES BUPIVACAINE HCI 0.75 PCT W/ DEXTROSE 8.25 PECENT 2 M", "code_information": [{"code": "333220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.67, "discounted_cash": 31.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY STANDARD 44MM COBALT CHROME COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "115370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3200.0, "discounted_cash": 1920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SYRNG 60 ML IRRIGATIOIN PISTON LF STRL", "code_information": [{"code": "DYND20302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.77, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL 79MM CRUCIATE FINNED ASCENT MAXIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3212.0, "discounted_cash": 1927.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY UR METER 350 ML 16FR LUBRI-SIL LF", "code_information": [{"code": "902216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.44, "discounted_cash": 28.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY URETHRAL 16FR 2 LEVEL SLIM LINE PLSTC W/ DRP UNDERPAD GLV LF", "code_information": [{"code": "772416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.51, "discounted_cash": 4.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYINSTRATION ROTATOR CUFF", "code_information": [{"code": "72203730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.5, "discounted_cash": 421.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYLUMBAR PUNCTURE 22G SFTY PLUS PEDI", "code_information": [{"code": "4302CSP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.19, "discounted_cash": 35.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYS ANESTHESIA ECHOSTIM BLOCK SET DYNJRA9043S", "code_information": [{"code": "DYNJRA9043S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.33, "discounted_cash": 58.4, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 76.53, "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 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": "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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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": 8312.0, "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": 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": 8312.0, "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 ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "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": "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": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 EYELID BY INJECTION", "code_information": [{"code": "68200", "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 FINGER FRACTURE EACH", "code_information": [{"code": "26755", "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "25500", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 9357.0, "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 9357.0, "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "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 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": 4620.0, "methodology": "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 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": "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": 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": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27825", "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": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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 METATARSAL FRACTURE", "code_information": [{"code": "28475", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 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": 9735.0, "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": 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": 9735.0, "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": 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": 9735.0, "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": "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 PENIS LESION GRAFT", "code_information": [{"code": "54111", "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": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "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": "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": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 RADIUS FRACTURE", "code_information": [{"code": "24650", "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "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": 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 SKULL FRACTURE", "code_information": [{"code": "62000", "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": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT 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": 4620.0, "methodology": "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": "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": 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 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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": "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": 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": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "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": "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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee 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"plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3527.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 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 THIGH FRACTURE", "code_information": [{"code": "27248", "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 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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": 9735.0, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "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 UTERUS INFECTION", "code_information": [{"code": "59830", "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": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT 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 BONE FRACTURE", "code_information": [{"code": "25622", "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 WRIST BONE FRACTURE", "code_information": [{"code": "25630", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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 WRIST BONE FRACTURE", "code_information": [{"code": "25635", "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": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT 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": 5628.0, "discounted_cash": 3376.8, "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": 2723.95, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "27818", "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": 2827.0, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2989.0, "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 BLADDER LESION", "code_information": [{"code": "51720", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "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 HMO", "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 POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "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 WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No 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": 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 BONE CYST", "code_information": [{"code": "20615", "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": 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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "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 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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2204.0, "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 MISCARRIAGE", "code_information": [{"code": "59812", "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": "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": 4620.0, "methodology": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 6074.0, "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 6074.0, "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 TARSAL BONE FX W/O MANIPULATION EA. 28450", "code_information": [{"code": "28450", "type": "CPT"}, {"code": "8125387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 5627.0, "discounted_cash": 3376.2, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 2723.46, "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "27506", "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": "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": 3103.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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 OF URETHRA LESION", "code_information": [{"code": "53260", "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": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.39, "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": "TRIAL CABLE LEAD", "code_information": [{"code": "5000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.75, "discounted_cash": 3.45, "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": 44.0, "discounted_cash": 26.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP MDV 10 ML", "code_information": [{"code": "MED0827", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 176.48, "discounted_cash": 105.89, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #1 LM/RL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5620-B-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5522.0, "discounted_cash": 3313.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #1 RM/LL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5676.0, "discounted_cash": 3405.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #2 LM/RL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5412.0, "discounted_cash": 3247.2, "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": 5412.0, "discounted_cash": 3247.2, "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": 2000.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #3 RM/LL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5522.0, "discounted_cash": 3313.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #4 LM/RL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #4 RM/LL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #1 LM/RL", "code_information": [{"code": "5610-F-101", "type": "CDM"}], "standard_charges": [{"gross_charge": 9340.0, "discounted_cash": 5604.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #2 RM/LL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5610-F-202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9602.0, "discounted_cash": 5761.2, "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": 9154.0, "discounted_cash": 5492.4, "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": 9340.0, "discounted_cash": 5604.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #4 LM/RL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5610-F-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7831.66, "discounted_cash": 4699.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #4 RM/LL", "code_information": [{"code": "5610-F-402", "type": "CDM"}], "standard_charges": [{"gross_charge": 3587.35, "discounted_cash": 2152.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #1 LM/RL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3614.0, "discounted_cash": 2168.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #1 RM/LL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3716.0, "discounted_cash": 2229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #2 LM/RL -9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #2 RM/LL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "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": 1630.0, "discounted_cash": 978.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #3 RM/LL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3542.0, "discounted_cash": 2125.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #3 RM/LL -9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3614.0, "discounted_cash": 2168.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #4 LM/RL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.39, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "TRIESENCE (TRIAMCINOLONE) 40MG/ML PF", "code_information": [{"code": "MED0523", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 470.1, "discounted_cash": 282.06, "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": "TRIMMING OF NONDYSTROPHIC NAILS; ANY NUMBER 11719", "code_information": [{"code": "11719", "type": "CPT"}, {"code": "44645881", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1068.0, "discounted_cash": 640.8, "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": 516.91, "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": "TRINITY ELITE 5CC MED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6470.0, "discounted_cash": 3882.0, "setting": "both", "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": 1072.0, "discounted_cash": 643.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLE PLAY DEVICE 2.0/2.4MM SCREWS", "code_information": [{"code": "AR-8737-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1687.5, "discounted_cash": 1012.5, "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": 983.5, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPOLE LAMITRODE 16C LEAD 60 CM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11800.0, "discounted_cash": 7080.0, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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 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": 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 DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "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": 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 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": 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": 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": "TRML DSTRJ IOS BVN 1ST 2 L/S", "code_information": [{"code": "64628", "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "TRML DSTRJ IOS BVN EA ADDL", "code_information": [{"code": "64629", "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": "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": 8450.0, "methodology": "fee 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": 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 10MM BLUNT TIP", "code_information": [{"code": "OMS-T10BT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.15, "discounted_cash": 259.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 12MMX150MM BLADELESS REPROCESSED", "code_information": [{"code": "B12XTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.66, "discounted_cash": 77.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 12X100 XCEL", "code_information": [{"code": "H12LP-R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.7, "discounted_cash": 50.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5MMX100MM CANN/SEAL", "code_information": [{"code": "CTS02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.7, "discounted_cash": 65.82, "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": 306.06, "discounted_cash": 183.64, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR AIRSEAL 5 X 120MM LAP OBTURATOR LOW PRO BLADELESS OPTICAL TIP", "code_information": [{"code": "IAS5-120LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 257.95, "discounted_cash": 154.77, "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": 113.99, "discounted_cash": 68.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 12MM X 150MM LAP OPTIC TIP ENDOPATH XCEL", "code_information": [{"code": "ETHB12XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.27, "discounted_cash": 130.96, "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": 173.36, "discounted_cash": 104.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5 MM LOPRO VERSAPORT", "code_information": [{"code": "NB5STFLP-R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.6, "discounted_cash": 68.16, "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": 311.14, "discounted_cash": 186.68, "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": 424.54, "discounted_cash": 254.72, "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": 69.52, "discounted_cash": 41.71, "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": 68.77, "discounted_cash": 41.26, "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": 279.59, "discounted_cash": 167.75, "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": 107.0, "discounted_cash": 64.2, "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": 89.99, "discounted_cash": 53.99, "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": 427.88, "discounted_cash": 256.73, "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": 99.79, "discounted_cash": 59.87, "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": 475.03, "discounted_cash": 285.02, "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": 244.04, "discounted_cash": 146.42, "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": 366.69, "discounted_cash": 220.01, "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": 291.44, "discounted_cash": 174.86, "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": 241.54, "discounted_cash": 144.92, "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": 207.03, "discounted_cash": 124.22, "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": 158.99, "discounted_cash": 95.39, "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": 89.99, "discounted_cash": 53.99, "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": 474.59, "discounted_cash": 284.75, "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": 241.54, "discounted_cash": 144.92, "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": 241.54, "discounted_cash": 144.92, "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": 207.03, "discounted_cash": 124.22, "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": 132.81, "discounted_cash": 79.69, "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": 182.62, "discounted_cash": 109.57, "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": 79.05, "discounted_cash": 47.43, "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": 92.9, "discounted_cash": 55.74, "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": 241.54, "discounted_cash": 144.92, "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": 170.4, "discounted_cash": 102.24, "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": 241.54, "discounted_cash": 144.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR OPTICAL ACCESS 5 X 100MM KII LP ZTHR", "code_information": [{"code": "CTR22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.35, "discounted_cash": 53.01, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SLEEVE 12MM XCEL", "code_information": [{"code": "2CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.03, "discounted_cash": 189.62, "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": 288.2, "discounted_cash": 172.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 1.6MM", "code_information": [{"code": "312.74", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.5, "discounted_cash": 114.3, "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": 314.9, "discounted_cash": 188.94, "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": 395.52, "discounted_cash": 237.31, "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": 79.05, "discounted_cash": 47.43, "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": 79.05, "discounted_cash": 47.43, "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": 384.88, "discounted_cash": 230.93, "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": 79.05, "discounted_cash": 47.43, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR THREADED 5MM 65MMINSUFFLATION PORT W/ WOODFORD SPIKE", "code_information": [{"code": "4216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.25, "discounted_cash": 24.15, "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": 254.11, "discounted_cash": 152.47, "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": 129.34, "discounted_cash": 77.6, "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": 194.3, "discounted_cash": 116.58, "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": 191.99, "discounted_cash": 115.19, "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": 88.75, "discounted_cash": 53.25, "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": 115.83, "discounted_cash": 69.5, "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": 349.59, "discounted_cash": 209.75, "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": 481.83, "discounted_cash": 289.1, "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": 266.72, "discounted_cash": 160.03, "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": 106.5, "discounted_cash": 63.9, "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": 432.07, "discounted_cash": 259.24, "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": 136.18, "discounted_cash": 81.71, "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": 568.11, "discounted_cash": 340.87, "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": 275.44, "discounted_cash": 165.26, "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": "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": 2211.0, "methodology": "fee schedule"}, {"payer_name": "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": "TRYPAN BLUE 0.06% (VISION BLUE) OPHTHALMIC SOLUTION 0.5ML", "code_information": [{"code": "MED0212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 189.69, "discounted_cash": 113.81, "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 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"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": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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": 5040.0, "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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for 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 6.0 MM HVLP CUFFED ORAL / NASAL ENDOTRACHEAL WITH MURPHY EYE AND BULL-NOSE TIP DYNJAETC60", "code_information": [{"code": "DYNJAETC60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.61, "discounted_cash": 3.97, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE COLLAR BUTTON VT 1.27MM BLUE FLPL 525-011", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "525-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30.94, "discounted_cash": 18.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE COLLECTION 6 ML 13MM X 100MM PINK TOP VENOUS BLOOD SILICONE COATED CAP", "code_information": [{"code": "367899", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.12, "discounted_cash": 1.87, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE CONNECTING 1/4IN X 12IN FEMALE", "code_information": [{"code": "8888301622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.43, "discounted_cash": 3.26, "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": 5307.75, "discounted_cash": 3184.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3.5MM CUFFED HIGH VOLUME LOW PRESSUREINTERMED LF", "code_information": [{"code": "86443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.22, "discounted_cash": 4.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3.5MM MAGILL UNCUFFED", "code_information": [{"code": "86463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.87, "discounted_cash": 3.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3MM UNCUFFED ORAL RAE", "code_information": [{"code": "86263", "type": "CDM"}, {"code": "272", 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"billing_class": "facility"}]}, {"description": "TUBING OXYGEN AIRLIFE LATEX FREE UCONNECT-IT CONNECTOR CRUSH RESISTANT STERILE DISPOSABLE CLEAR 7FT", "code_information": [{"code": "1350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 204.35, "discounted_cash": 122.61, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING S9 SLIM SJQRM36810", "code_information": [{"code": "SJQRM36810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.3, "discounted_cash": 31.98, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING STERILIZATION 3IN X 100 FOOT INSTRUMENT ROLL", "code_information": [{"code": "MPP200410S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.59, "discounted_cash": 12.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING STERILIZATION 4IN X 100 FOOT INSTRUMENT ROLL PAPER POLY LATEX FREE", "code_information": [{"code": "MPP200415S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.27, "discounted_cash": 17.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING STERILIZATION 6IN X 100 FOOT INSTRUMENT ROLL PAPER POLY LATEX FREE", "code_information": [{"code": "MPP200420S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.91, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCT 1/4IN X 12FT CLR NONCONDUCTIVE SMTH PLSTC W/ MAXI GRIP CONNECTORS AN", "code_information": [{"code": "N612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION 1/4IN X 12FT CONNECTING NON CONDUCTIVE LF STRL", "code_information": [{"code": "DYND50252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.43, "discounted_cash": 3.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUPPLY", "code_information": [{"code": "SMI-XTUBING", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING TUMESCENT INFILTRATION ITS-10", "code_information": [{"code": "ITS-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.5, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING TUMESCENT INFILTRATION TUBING", "code_information": [{"code": "HKTUBE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.5, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING Y-TYPE LIFECARE PCA SET MINIBORE PAV 0.2 MICRON FILTER BACKCHECK VALVE 86IN", "code_information": [{"code": "142790489", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.46, "discounted_cash": 21.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINSUFFLATION 1 UC HIGH FLOW MECTRAGLOW DISP", "code_information": [{"code": "MG2007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.5, "discounted_cash": 20.7, "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": 25.99, "discounted_cash": 15.59, "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": "TUNNELER SURG 11GA X 8IN W/ SHEATH", "code_information": [{"code": "T11X8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.98, "discounted_cash": 58.79, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 50CM", "code_information": [{"code": "ACCK3050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.25, "discounted_cash": 150.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TWIST 11MM SABTALOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "102-10-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "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": 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{"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 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"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": 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"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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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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", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "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 PPO", "standard_charge_dollar": 279.98, "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": 200.31, "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": "AETNA", "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", "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": 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": "ULTRASOUND GEL 0.5LTR LIQUASONIC", "code_information": [{"code": "408502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.82, "discounted_cash": 44.89, "setting": "both", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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": 1519.76, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "UNDERPAD PROTECTION PLUS 23 X 36 MSC281229C", "code_information": [{"code": "MSC281229C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "UNDERWEAR ADULT PULL-ON XL", "code_information": [{"code": "PUW1625", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "UNDERWEAR ULTRA PROTECTIVE UNDERWEAR SMALL/MEDIUM 34\" - 46\" EXTRA HEAVY ABSORBENCY", "code_information": [{"code": "1445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "UNDERWEAR XL ULTRA HEAVY ABSORBENCY", "code_information": [{"code": "1455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.29, "discounted_cash": 1.97, "setting": "both", "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": 174.44, "discounted_cash": 104.66, "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": 90.1, "discounted_cash": 54.06, "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": "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 CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 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", "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": 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": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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": 1952.0, "methodology": "fee schedule"}, {"payer_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 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 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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 8450.0, "methodology": "fee 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"}], "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 HYSTSC PX UTERUS", "code_information": [{"code": "58579", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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": 2204.0, "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "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 LAPAROSCOPIC PROCEDURE LIVER 47379", "code_information": [{"code": "47379", "type": "CPT"}, {"code": "4240120", "type": 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"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": 2578.75, "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", 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4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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 TESTIS", "code_information": [{"code": "54699", "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": 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": "UHC", "standard_charge_dollar": 9357.0, "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": 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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee 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": 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": 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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"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": 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": 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 MUSCSKEL PX HEAD", "code_information": [{"code": "21499", "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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"}], "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": 1301.0, "methodology": "fee schedule"}, {"payer_name": 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"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 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3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3001.76, "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": "UNLISTED PROCEDURE ANUS 46999", "code_information": [{"code": "46999", "type": "CPT"}, {"code": "12971444", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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 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{"payer_name": "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": 2019.24, "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 COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": 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{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 537.24, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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", "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": 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": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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 CONJUNCTIVA", "code_information": [{"code": "68399", "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 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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": 9735.0, "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 EXC PRESSURE ULC", "code_information": [{"code": "15999", "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 MALE GENITAL SYS", "code_information": [{"code": "55899", "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": 2204.0, "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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 2204.0, "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", "standard_charge_dollar": 4620.0, "methodology": "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", "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": 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": 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 PHRNX ADND/TNSL", "code_information": [{"code": "42999", "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 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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 URINARY SYSTEM", "code_information": [{"code": "53899", "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 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 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": 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": 2204.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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, "estimated_discounted_cash": 330.73, "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 POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 1952.0, "methodology": "fee schedule"}, {"payer_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": 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": "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": 4382.0, "methodology": "fee schedule"}, {"payer_name": "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": "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 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": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2989.0, "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.74, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.89, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "URETERAL ENDOSCOPY THROUGH URETEROTOMY 50970", "code_information": [{"code": "50970", "type": "CPT"}, {"code": "1482338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "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": 3140.0, "discounted_cash": 1884.0, "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": 1519.76, "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": "URETEROSCOPY THROUGH URETEROTOMY W/ 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"standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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, 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"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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.28, "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 821.0, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 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": 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": "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 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": 1390.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 570.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 570.59, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 703.75, "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": 516.24, "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": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 715.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 863.19, "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 Abdomen Limited 76705", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "625610", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1052.0, "discounted_cash": 631.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 431.84, "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": 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": 431.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 532.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 390.71, "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": 541.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 653.29, "methodology": "fee schedule"}, {"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": "US Aorta Complete 93978", "code_information": [{"code": "93978", "type": "CPT"}, {"code": "631475", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 670.72, "maximum": 8450.0, "gross_charge": 1390.0, "discounted_cash": 834.0, "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": 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": "US Aorta Renal 76770", "code_information": [{"code": "76770", "type": "CPT"}, {"code": "1748454", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1182.0, "discounted_cash": 709.2, "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": 485.21, "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": 485.21, "methodology": "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": 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{"payer_name": "AETNA", "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": 342.43, "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", "standard_charge_dollar": 474.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 572.56, "methodology": "fee schedule"}, {"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": "US Duplex Arterial LE Bl 93925", "code_information": [{"code": "93925", "type": "CPT"}, {"code": "1748366", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 974.26, "maximum": 8450.0, "gross_charge": 1315.0, "discounted_cash": 789.0, "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": 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": "US Duplex Arterial LE Unilateral 93926", 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"discounted_cash": 834.0, "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": 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": "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": 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": 0.51, "methodology": "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": 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "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", "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": 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 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": 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": 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 Ea Adl Gestational > 14 wks 76810", "code_information": [{"code": "76810", "type": "CPT"}, {"code": "1748458", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 487.0, "discounted_cash": 292.2, "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": 199.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 199.91, "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 PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 246.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 180.87, "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": 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", "standard_charge_dollar": 250.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 302.42, "methodology": "fee schedule"}, {"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": "US Extremity, Nonvascular, Limited, Bilateral", "code_information": [{"code": "76882", "type": "CPT"}, {"code": "1554229", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1577.0, "discounted_cash": 946.2, "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": 647.35, "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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 647.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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{"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": 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", "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": 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 Pelvic/Trans (Non-OB) 76856/76830", "code_information": [{"code": "76856", "type": "CPT"}, {"code": "34060825", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1140.0, "discounted_cash": 684.0, "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": 467.97, "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": 467.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 577.18, "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": 423.39, "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": 587.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 707.94, "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"}, {"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1221.0, "discounted_cash": 732.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 501.22, "methodology": "fee schedule"}, {"payer_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": 501.22, "methodology": "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": 618.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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": 453.47, "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": 628.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 758.24, "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 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": 1221.0, "discounted_cash": 732.6, "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": 501.22, "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": 501.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 618.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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": 453.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 628.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 758.24, "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 Pelvis Non-OB Limited 76857", "code_information": [{"code": "76857", "type": "CPT"}, {"code": "630925", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 752.0, "discounted_cash": 451.2, "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": 308.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 308.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 380.73, "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": 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": 279.29, "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": "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": 387.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 466.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, 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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": 154.34, "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 PPO", "standard_charge_dollar": 190.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 139.64, "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": 193.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 233.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Soft Tissue other body area 76999", "code_information": [{"code": "76999", "type": "CPT"}, {"code": "36944328", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 376.0, "discounted_cash": 225.6, "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": 154.34, "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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 154.34, "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 PPO", "standard_charge_dollar": 190.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": 139.64, "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": "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": 193.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 233.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRANSRECTAL", "code_information": [{"code": "76872", "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": 1952.0, "methodology": "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", "standard_charge_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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "standard_charge_dollar": 0.51, "methodology": "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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": 939.0, "discounted_cash": 563.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 385.45, "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 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": 385.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 475.41, "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": 348.74, "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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1301.0, "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": 323.47, "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 PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 398.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": 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"discounted_cash": 225.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 154.34, "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 HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 154.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 190.36, "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 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": 139.64, "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": "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": 193.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 233.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Venous Doppler Extremity Bl 93970", "code_information": [{"code": "93970", "type": "CPT"}, {"code": "1748374", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 721.56, "maximum": 8450.0, "gross_charge": 1390.0, "discounted_cash": 834.0, "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": 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": "US Venous Doppler Extremity Unilat 93971", "code_information": [{"code": "93971", "type": "CPT"}, {"code": "1714174", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 441.84, "maximum": 8450.0, "gross_charge": 1390.0, "discounted_cash": 834.0, "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": 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": "US Venous Doppler Extremity Unilat 93971", "code_information": [{"code": "93971", "type": "CPT"}, {"code": "1714174", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 441.84, "maximum": 8450.0, "gross_charge": 1390.0, "discounted_cash": 834.0, "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": 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": "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": 1301.0, "methodology": "fee schedule"}, {"payer_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 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 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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 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": 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, "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": "UVULECTOMY EXCISION OF UVULA 42140", "code_information": [{"code": "42140", "type": "CPT"}, {"code": "1969179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 537.24, "maximum": 8450.0, "gross_charge": 1110.0, "discounted_cash": 666.0, "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": 537.24, "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": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ultrasound Charges", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "750915", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 37.51, "maximum": 8450.0, "gross_charge": 101.0, "discounted_cash": 60.6, "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": 41.46, "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": 41.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.51, "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": 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": "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", "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": 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": "Ultrasound Measurement Of Bone Density In Shin 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.76, "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": 18.19, "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": 43.2, "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": 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": 26.74, "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": "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 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "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": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "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": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "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": 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"standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "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 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{"payer_name": "AETNA", "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 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"standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/T/O & VAG REPAIR", "code_information": [{"code": "58263", "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": 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": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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": 2268.5, "maximum": 8450.0, "gross_charge": 4687.0, "discounted_cash": 2812.2, "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": 2268.5, "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", "code_information": [{"code": "58260", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_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": "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": 30.19, "discounted_cash": 18.11, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SPIROMETER INCENTIVE 4000ML 1-WAY 001901A", "code_information": [{"code": "1901A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.75, "discounted_cash": 6.45, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE STPCK CLR 1-WAY IV ROTATING ADAPTER FEMALE TO MALE LUER LOCK PLSTC DISP", "code_information": [{"code": "G06889", "type": "CDM"}], "standard_charges": [{"gross_charge": 46.58, "discounted_cash": 27.95, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE STPCK CLR THREE WAY 2 FEMAL LUER LOCKS TO MALE LUER LOCK ROTATING ADAPTER", "code_information": [{"code": "G06540", "type": "CDM"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 27.6, "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": 21.1, "discounted_cash": 12.66, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1GM/NS 250ML IVPB", "code_information": [{"code": "MED0215", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.99, "discounted_cash": 16.19, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 500MG VIAL", "code_information": [{"code": "MED0213", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.03, "discounted_cash": 10.82, "setting": "both", "billing_class": "facility"}]}, {"description": "VANGRD 360 DSTL FMRL AUG 70X10MM RL/LM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3122.0, "discounted_cash": 1873.2, "setting": "both", "billing_class": "facility"}]}, {"description": "VANGRD 360 DSTL FMRL AUG 75X5MM LL/RM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3165.6, "discounted_cash": 1899.36, "setting": "both", "billing_class": "facility"}]}, {"description": "VANGRD SSK PSC TIB BRG 20X79/83", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "183910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4.1, "discounted_cash": 2.46, "setting": "both", "billing_class": "facility"}]}, {"description": "VANGRD SSK PSC TIB BRG 24X87/91", "code_information": [{"code": "183934", "type": "CDM"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 2412.0, "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": 54.72, "discounted_cash": 32.83, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 1084.66, "discounted_cash": 650.8, "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": "VARIABLE LOCK SCREW 4.75X20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 205.2, "setting": "both", "billing_class": "facility"}]}, {"description": "VARIABLE LOCK SCREW 4.75X50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 205.2, "setting": "both", "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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 1301.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 1301.0, "methodology": "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": 1301.0, "methodology": "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": 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": 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": "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": 1519.76, "maximum": 8450.0, "gross_charge": 3140.0, "discounted_cash": 1884.0, "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": 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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": 3140.0, "discounted_cash": 1884.0, "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 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"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 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"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 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{"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "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", 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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": "VEGA SPAN 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-61006-1441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15780.0, "discounted_cash": 9468.0, "setting": "both", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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", "standard_charge_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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 348.07, "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 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": 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": 1301.0, "methodology": "fee schedule"}, {"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": 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": 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": 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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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", "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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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": 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": 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": "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": 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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": "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": 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": "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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "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": 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": 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 HUMID COMPACT STRAIGHT", "code_information": [{"code": "19402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.21, "discounted_cash": 6.73, "setting": "both", "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", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "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": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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 ADHSV 0.66 ML LIQ MASTISOL", "code_information": [{"code": "496-0523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.18, "discounted_cash": 5.51, "setting": "both", "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": 3.16, "discounted_cash": 1.9, "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": 315.84, "discounted_cash": 189.5, "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.6, "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": 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"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 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"plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.18, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.19, "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 FEM LT SZ F3 V0100107", "code_information": [{"code": "V0100107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.75, "discounted_cash": 632.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VIS ADPT GUIDE LGNP KIT1", "code_information": [{"code": "V0100109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1717.5, "discounted_cash": 1030.5, "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": 119.85, "discounted_cash": 71.91, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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 D HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "1235825", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 295.0, "discounted_cash": 177.0, "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, 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "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 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{"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": 2723.95, "maximum": 9357.0, "gross_charge": 5628.0, "discounted_cash": 3376.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "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-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": 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"standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2723.95, "methodology": "fee schedule"}, {"payer_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 CAT500 (each Package CAT178)", "code_information": [{"code": "CAT500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4465.5, "discounted_cash": 2679.3, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 224.91, "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": 105.47, "discounted_cash": 63.28, "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": 250.41, "discounted_cash": 150.25, "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": 282.11, "discounted_cash": 169.27, "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": 329.49, "discounted_cash": 197.69, "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": 118.13, "discounted_cash": 70.88, "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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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": 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": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee 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": "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": 0.51, "methodology": "fee 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": 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": "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 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[{"gross_charge": 728.51, "discounted_cash": 437.11, "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 SCOPE", "code_information": [{"code": "TM500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.1, "discounted_cash": 39.06, "setting": "both", "billing_class": "facility"}]}, {"description": "WARMER SCOPE STERILS LAPAROSCOPIC ECONOMY TM500DE", "code_information": [{"code": "TM500DE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.08, "discounted_cash": 40.85, "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 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"discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER 17MM FSOMSYN01-8200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FSOMSYN01-8200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER 3.0 P20-030-DW00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-030-DW00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 201.5, "discounted_cash": 120.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER 7.0MM SLOTTED BOWL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-0707-WFS0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER ANIS 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"discounted_cash": 40.04, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 4MM BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.44, "discounted_cash": 62.66, "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": 63.6, "discounted_cash": 38.16, "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": 70.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW PATELLA 4.0MM 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"AR-8740W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.88, "discounted_cash": 45.53, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SURG FOR 3.75 MM SCREW TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 108.4, "discounted_cash": 65.04, "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": 237.92, "discounted_cash": 142.75, "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": 6.5, "discounted_cash": 3.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER TRAP DRYLIND ADLT/PEDI", "code_information": [{"code": "115-043022-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.34, "discounted_cash": 46.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER TRAP DRYLIND ADLT/PEDI 125-00005-00", "code_information": [{"code": "125-00005-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.16, "discounted_cash": 40.9, "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": 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[{"code": "BW25G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.83, "discounted_cash": 15.5, "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": 14.19, "discounted_cash": 8.51, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": "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": 0.41, "methodology": "fee 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"standard_charge_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": 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"RC"}], "standard_charges": [{"gross_charge": 2885.0, "discounted_cash": 1731.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE 20MM X 4.5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "46S0-2045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3886.0, "discounted_cash": 2331.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE BODY ALIGNMENT FOAM POSITIONING DEVON", "code_information": [{"code": "31143392", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.56, "discounted_cash": 23.74, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON 5MM X 22MM X 16MM FOR FLATFOOT DEFORMITY CORRECTION", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "403205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 1140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON 7MM X 22MM X 16MM FOR FLATFOOT DEFORMITY CORRECTION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "403207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1641.6, "discounted_cash": 984.96, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON BONE 8 X 14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PCOT-181408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4700.0, "discounted_cash": 2820.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE EVANS 22 X 20 X 10MM ALLOPURE 10MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8666-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5418.0, "discounted_cash": 3250.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE EVANS 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"type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 2106.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ILIAC CREST 24-26CM", "code_information": [{"code": "400411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2596.86, "discounted_cash": 1558.12, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ILIAC CREST TRICORTICAL BLOCK 30MM X 15MM X 4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-0915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1726.0, "discounted_cash": 1035.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE LEGION TIB CONE ID 22 SHORT 71935388", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31700.0, "discounted_cash": 19020.0, "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 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "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 29750", "code_information": [{"code": "29750", "type": "CPT"}, {"code": "10171440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 331.8, "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": 267.65, "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": "WELCH ALLYN 6.0 V POWER TRANSFORMER ONLY FOR SIGMOIDOSCOPES AND ANOSCOPES; 5.0 FT/1.5 M CORD; 100-24", "code_information": [{"code": "73305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.88, "discounted_cash": 316.13, "setting": "both", "billing_class": "facility"}]}, {"description": "WEREWOLF FASTSEAL 6.0 HEMOSTASIS WAND 72290042", "code_information": [{"code": "72290042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1211.81, "discounted_cash": 727.09, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "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 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historical data found for payer/plan and coding combination", "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": "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"}], 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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[{"gross_charge": 4.84, "discounted_cash": 2.9, "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": 4.84, "discounted_cash": 2.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE COMPRESSION THREAD 200MM 2.8MM X 10MM", "code_information": [{"code": "3.118.010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.54, "discounted_cash": 126.92, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE COMPRESSION THREAD 200MM 2.8MM X 15MM", "code_information": [{"code": "3.118.015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.54, "discounted_cash": 126.92, "setting": "both", "billing_class": "facility"}]}, 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"standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 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"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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": "WORKING CHANNEL FOR SHIELD DELIVERY SYSTEM", "code_information": [{"code": "6129.1001S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.5, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND CLEANSER SHUR-CLENS 20ML", "code_information": [{"code": "420813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.95, "discounted_cash": 4.17, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND CLOSURE ADHESIVE SYL-WC-010", "code_information": [{"code": "SYL-WC-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.5, "discounted_cash": 140.7, "setting": "both", "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": 234.5, "discounted_cash": 140.7, "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 PREP ADDL 100 CM", "code_information": [{"code": "15003", "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": "WOUND THERAPY DEVICE PICO 7 15 X 15CM", "code_information": [{"code": "66022005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.15, "discounted_cash": 531.09, "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": 823.33, "discounted_cash": 494.0, "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": 1.8, "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": 7.42, "discounted_cash": 4.45, "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": 1.8, "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": 1.8, "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": 4.75, "discounted_cash": 2.85, "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": 4.2, "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": 8.11, "discounted_cash": 4.87, "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": 46.25, "discounted_cash": 27.75, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 1 LAYR CH500 BL 45X45 CH510045", "code_information": [{"code": "CH510045", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.73, "discounted_cash": 2.24, "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": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 2 COLOR 54X54 DISPOS CH4G0054", "code_information": [{"code": "CH4G0054", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.55, "discounted_cash": 5.73, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 20X20", "code_information": [{"code": "CH1G0020", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 3.24, "discounted_cash": 1.94, "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": 1.8, "setting": "both", "billing_class": 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"standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 86.9, "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": 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": "Wound Culture", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "633908", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 452.0, "discounted_cash": 271.2, "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": 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": 167.87, "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": "X FUSE C-LARGE ANGLE 0 DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXF-XL0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2670.7, "discounted_cash": 1602.42, "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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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-POST 20MM SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "118-70620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4386.0, "discounted_cash": 2631.6, "setting": "both", "billing_class": "facility"}]}, {"description": "X-POST COUNTERSINK SMALL", "code_information": [{"code": "118-02076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 958.21, "discounted_cash": 574.93, "setting": "both", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 8450.0, "methodology": "fee 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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_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", "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": 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": 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 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": 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 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": 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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": 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "standard_charge_dollar": 8450.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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": 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", "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", "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": 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", "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": 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", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "standard_charge_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": 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "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", "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": 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", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 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": 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": 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", "standard_charge_dollar": 1301.0, "methodology": "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": 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"}], "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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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 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": 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": 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": 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": 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": 1952.0, "methodology": "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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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": 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": 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", "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": 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": 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", "standard_charge_dollar": 8450.0, "methodology": "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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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 EYE FOR FOREIGN BODY", "code_information": [{"code": "70030", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": 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": "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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 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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "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 WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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", "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", "standard_charge_dollar": 0.51, "methodology": "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 0.51, "methodology": "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": 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": 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", "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": 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": 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": 1301.0, "methodology": "fee schedule"}, {"payer_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": 4620.0, "methodology": "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": 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"}, {"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 DUCT", "code_information": [{"code": "77053", "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", "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": 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": 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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"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": "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_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 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", "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": 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", "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"}, {"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": "74450", "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", "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": 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"}], "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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": 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 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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", "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": 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": 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": 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": 0.51, "methodology": "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": 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-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": 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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "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": 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": "X-WRAP 4 X 6CM", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "XWP-30406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE6 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5232.0, "discounted_cash": 3139.2, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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 CPLX WO ECP", "code_information": [{"code": "66982", "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": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "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": 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 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"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": 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": "XCPSL CTRC RMVL CPLX INSJ 1+", "code_information": [{"code": "66989", "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": 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": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 250.0, "discounted_cash": 150.0, "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": 418.75, "discounted_cash": 251.25, "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": 0.51, "methodology": "fee 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", 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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": 180.87, "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": 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": 250.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 302.42, "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": 487.0, "discounted_cash": 292.2, "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": 199.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "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": 199.91, "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 POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 246.56, "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": 180.87, "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": 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": 250.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 302.42, "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": 376.0, "discounted_cash": 225.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 154.34, "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": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 154.34, "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": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 190.36, "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": 139.64, "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": 193.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 233.49, "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": 487.0, "discounted_cash": 292.2, "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": 199.91, "methodology": "fee schedule"}, {"payer_name": "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": 199.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "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": 246.56, "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": 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": 180.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_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": 250.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 302.42, "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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "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 WHOLE HEALTH", "standard_charge_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": 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": 1952.0, "methodology": "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 4620.0, "methodology": "fee schedule"}, {"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": 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": 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": 1952.0, "methodology": "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": 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": 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", "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", "additional_payer_notes": "No historical data found for payer/plan and coding 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": 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": 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": "XWRAP DRY 4 X 8CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "XDW-40408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9504.0, "discounted_cash": 5702.4, "setting": "both", "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", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.92, "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": "Y- PLATE 2 HOLE BROAD T10 626992", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2554.0, "discounted_cash": 1532.4, "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": 442.52, "discounted_cash": 265.51, "setting": "both", "billing_class": "facility"}]}, {"description": "YANKAUER SUCTION CANNULA STERILE RIGID WITH OPEN TIP NO VENT OR87", "code_information": [{"code": "OR87", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "YANKAUER SUCTION OPEN TIP RIGID SMOOTH TIP AND EYE ARGYLE LFINSTR", "code_information": [{"code": "8888505115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "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": 0.51, "methodology": "fee schedule"}, {"payer_name": "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": "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"}], 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